# Concussion Protocol



## pewpew (Oct 27, 2018)

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...


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## TangoCity (Oct 28, 2018)

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.


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## coachrefparent (Oct 28, 2018)

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.


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## RedCard (Oct 28, 2018)

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.


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## younothat (Oct 28, 2018)

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/Downloads/Resources/CalSouthConcussionParentFactSheet5.25.17V4.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.


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## Surfref (Oct 28, 2018)

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.


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## pewpew (Oct 28, 2018)

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...........


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## timbuck (Oct 29, 2018)

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?


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## El Clasico (Oct 29, 2018)

Question???
If a 3rd party calls the paramedics, who gets billed for that?


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## Eagle33 (Oct 29, 2018)

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.
> ...


Try this https://www.calsouth.com/en/playersafety/


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## Surfref (Oct 29, 2018)

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.
> ...


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.


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## timbuck (Oct 29, 2018)

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?


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## Eagle33 (Oct 29, 2018)

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.


I'm suspecting it is due to shorter rosters on club teams compared to HS teams


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## Eagle33 (Oct 29, 2018)

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?



http://www.cifstate.org/sports-medicine/concussions/index


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## Surfref (Oct 29, 2018)

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.
> 
> ...


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.


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## Speed (Oct 29, 2018)

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.
> ...


And do clubs actually ask to see the MD note allowing the player to play? Our coach could care less....


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## timbuck (Oct 29, 2018)

They should.  Or I think they could be held liable if another head injury occurs prior to the doctor clearance.


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## Just A Dad (Oct 29, 2018)

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....


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.


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## Surfref (Oct 29, 2018)

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.


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....


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.


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## Surfref (Oct 29, 2018)

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.


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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## timbuck (Oct 29, 2018)

Any recommendations on where to go for baseline testing?


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## GKDad65 (Oct 29, 2018)

In our society of over-triage and "Google" MD's there'll be an ambulance, or two, at every game.
Perhaps we should expect a helicopter be on stand-by for all games.
P.S.: There is very little definitive "treatment" an ambulance crew can administer.  What they offer is a ride to the hospital,
maybe faster, maybe slower than driving on your own.

Parents, advocate for your kids, stand up and take them off the field, it's your kid, and you're paying for all this fun!
If your kid gets their "bell-rung" pull'em off.  For crying-out-loud this is just youth soccer.


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## pewpew (Oct 29, 2018)

El Clasico said:


> Question???
> If a 3rd party calls the paramedics, who gets billed for that?


The only bill anyone would receive is by the agency that transports the patient to the hospital. The responding FD does not bill anyone for a response. That's your tax dollars at work.  LA City FD uses their own units to transport. You still get a bill for the ride. LACoFD contracts with private ambulance companies. The only bill you'll get is from the ambulance company. Just depends which FD. Some contract out..many use their own.
Average bill is roughly in the $800-$1000 range. (Last year my wife was transported from Downtown LA to County USC and the bill was $900+/-  Insurance covered it minus the copay.
And get this one. Let's say this happened at the Lancaster Soccer Complex. Based on all the info I've been given this player would've met trauma center criteria due to the mechanism of injury and +KO. For years the AV didn't have trauma center rated hospitals. (They do currently) Which means this player would've been flown via helicopter to Children's LA or another trauma center in the LA area. And there wouldn't have been a bill for the ride!!
Now let's say a small FD like West Covina who contracts out to Mercy Air flies you out.  I don't know what that bill will be. I don't think I even want to know. (I know if I do a bit of digging I can find out.)


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## GunninGopher (Oct 29, 2018)

Speed said:


> And do clubs actually ask to see the MD note allowing the player to play? Our coach could care less....


The league and Cal-South require it.

The question is, are all of them being reported. I know that there are referees that aren't. My daughter's team has had to report 2 that weren't reported by the CR.

As a referee I've had a similar experience with coaches as Surf Ref in Presidio/SDDA games. About half are real jerks about it. I haven't had them argue too much. If I reported that they were trying to get me to overlook it I believe that they would get straightened out by the league.

I think it will be a non-issue in a couple years.


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## coachrefparent (Oct 29, 2018)

pewpew said:


> The only bill anyone would receive is by the agency that transports the patient to the hospital. The responding FD does not bill anyone for a response. That's your tax dollars at work.  LA City FD uses their own units to transport. You still get a bill for the ride. LACoFD contracts with private ambulance companies. The only bill you'll get is from the ambulance company. Just depends which FD. Some contract out..many use their own.
> Average bill is roughly in the $800-$1000 range. (Last year my wife was transported from Downtown LA to County USC and the bill was $900+/-  Insurance covered it minus the copay.
> And get this one. Let's say this happened at the Lancaster Soccer Complex. Based on all the info I've been given this player would've met trauma center criteria due to the mechanism of injury and +KO. For years the AV didn't have trauma center rated hospitals. (They do currently) Which means this player would've been flown via helicopter to Children's LA or another trauma center in the LA area. And there wouldn't have been a bill for the ride!!
> Now let's say a small FD like West Covina who contracts out to Mercy Air flies you out.  I don't know what that bill will be. I don't think I even want to know. (I know if I do a bit of digging I can find out.)


Mercy Air would run about $12-$16K billed. Government owned aircraft cannot charge for transport.


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## SoCal GK mom (Oct 29, 2018)

timbuck said:


> Any recommendations on where to go for baseline testing?


Children's Hospital of Los Angeles Sports Medicine Group does baseline concussion testing. I think it costs something like $25. They have outpatient locations spread around the LA area: https://www.chla.org/sports-medicine-program

They're great for concussion management and for other sports-related injuries (ie orthopedics), too. Highly recommend.


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## pewpew (Oct 29, 2018)

coachrefparent said:


> Mercy Air would run about $12-$16K billed. Government owned aircraft cannot charge for transport.


I didn't say they did. I was just putting it into perspective for those that didn't know about a patient being flown out and it not costing them. 
However..you can purchase an insurance policy thru companies like Reach Air Ambulance Service. It's a very small price to pay to cover your whole family in the event you ever need air transport. A lot of people who camp/ride in the desert do this due to the very nature of where they are riding and the hazards that come with it. A busy weekend camping and riding out at Ocotillo Wells or Glamis will have more than it's share of FD responses. A few years ago we were out at Ocotillo and a saw the air ambulance out there three different times. Here's an example of people getting rescued because they were in a place where they weren't prepared to be in and had no business being in to begin with. Free helicopter ride and they can tell their friends to check the video out of them on Youtube.


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## rainbow_unicorn (Oct 30, 2018)

So as a parent how do you determine whether you should call 911 for an ambulance or whether you should just drive your kid to the ER after this type of injury?


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## Just A Dad (Oct 30, 2018)

When it happened to my daughter she jumped for a header and had her legs taken out and hit her head against the ground. She jumped right up but the ref noticed how hard she hit and asked her some questions and pulled her right off. I dont think she needed 911 called but i should have taken her to the ER instead of waiting a day. Again poor parenting on my part and I should have known if a ref is pulling my kid out of the game he sees something that's not right and I should have taken her to the ER. I have 2 girls, one has had a concussion and one has torn her ACL twice. the one who tore her ACL i had her in the doctor that day and i waited a day for the concussion. knowing what i know now the ACL could have waited a day the concussion should have been checked that day.


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## Eagle33 (Oct 30, 2018)

timbuck said:


> Any recommendations on where to go for baseline testing?


My kids team have done it at UCI for couple of years. It was provided by his club and was required before season start.


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