I get knocked down, but I get up again!

After talking about how awesome Twisted Sister were, I might have got you excited about the classic Chumbawamba song Tubthumping! Such a great song, but again another one-hit wonder that now occasionally finds its way to be played at awkward school reunions and trivia nights.  However, as interesting as random bands are and as pointless as school reunions are, I am not going to talk about either. Instead, let’s talk head injuries!
 
Whilst for many people, a head injury might be preferable to going to their school reunion, I don’t want to seem blasé about one of the most significant issues with which we have to deal as teachers, coaches and outdoor instructors.
 
Concussions are what I would describe as a hidden injury. Whilst sometimes it’s extremely obvious that someone has suffered a concussion, when they’re struggling to remember what you said to them 30 seconds ago, there are also times where the injury goes quite unnoticed. Sometimes, after a hit to the head or a massive body collision, a proper assessment isn’t done and the student continues to play on.
 
One of the biggest problems with concussions, from a first aid point of view, is that the signs and symptoms are not blatantly obvious. If for example someone breaks an arm, especially if it’s a protruding injury, you can see it’s broken from satellite imagery. If it’s graze or laceration, there’s usually lots of blood and so it’s time to glove up and stop that bleeding. There is a reason why people say “bleedingly obvious,” and you’ll understand exactly what they mean, if you’ve treated someone with an open wound, let alone someone who’s taken a dive in a bed of oysters… but that’s a story for another time.
 
Head injuries and concussions however, that don’t involve lots of bleeding, aren’t always so obvious and nor is the recovery process. When you’ve broken that arm at right angles and passers by with no first aid training feel nauseated just looking at it, it’s obvious you need to get that looked at by a doctor. The process is quite clear from now on in. You go to the hospital, the triage nurse looks at you and goes ‘Oh woah! That’s broken!’ The old lady you sit down next to in the waiting room goes ‘Oh woah! That’s broken!’ and finally after a 6 hour wait in emergency, the doctor said ‘Oh woah! That’s broken, but we’d better get it X-rayed just to be sure!’
 
However, with head injuries, it’s not so clear cut. Because we can’t see an obvious trauma, we can often risk not even considering that an injury has occurred. The student after all got back up and is playing again. The student might not feel too bad, just a little dazed… but can ‘walk it off’. Unfortunately, inside the student’s head, the brain has just been bounced around and is suffering the effects of a mild concussion. If however, a student has a major concussion, it’s far easier to notice and remove the student from the field or activity. Thankfully, our awareness of and attention to major concussions has improved dramatically in recent years. However, it’s the mild concussions that worry me, as they can remain hidden for an extended period of time.
 
When someone suffers a concussion, they should seek medical advice and have a clear recovery plan laid out for them. However, with a mild concussion, medical advice is not always sought and the student doesn’t rest and recover, but instead, goes to the next training session increasing the risk of more significant trauma and then onto the next game, once again at increased risk. A concussion on top of another concussion, on top of another one can have a massive multiplier effect and lead to further damage to the brain being caused. Traumatic brain injury and/or CTE (Chronic Traumatic Encephalopathy) can result.
 
As I’m not a doctor, and there’s far better medical information and advice on the specifics around TBI and CTE I won’t go into all the details here. But as a first teacher, coach or instructor and often the first responder, we should be ensuring we are baseline testing our students prior to commencing high risk activists such as extreme sports and contact sports. We should be mandating helmets or head gear wherever possible and also remaining situationally aware throughout the activity or game looking for big hits to the body or head that might result in the mild concussion that can be so easily overlooked as it’s not bleedingly obvious to the old lady in the emergency department. It’s easy to test for a concussion, but much much harder to deal with the fallout if you don’t.
 
As educators, we want to challenge our students and help them get the most out of sports, the outdoors and every other opportunity that school affords them. We want them to out-live us and be forced to go to those awkward school reunions, so they can pretend to be far more successful than all the people they hated at school and claim they invented the ‘Post It Note’ or are now an internet Billionaire having invented ‘Fake Block’. Making our students suffer awkward conversations at school reunions to which we don’t have to go, is good! However, letting them suffer from a traumatic brain injury or CTE from multiple concussions when we can so easily check with something like the International Diagnostic tool, is unacceptable.
 
We do have a very high duty of care for our students and being aware of the risks involved in concussions and also how we can effectively respond and manage them, is vital for us as teachers, coaches and instructors. If you haven’t done so already, do some research, go to a seminar or listen to a podcast on this. The more we understand about concussions, the more we can do to recognise and treat them as we would any other traumatic injury.
 
For more clinic information speak with your doctor and a few useful resources below:
 
CTE
 
https://concussionfoundation.org/CTE-resources/what-is-CTE
 
Malcolm Gladwell – Revisionist History Podcast
 
https://itunes.apple.com/au/podcast/burden-of-proof/id1119389968?i=1000412178526&mt=2
 
Pocket Concussion Recognition Tool - updated 2017
 
http://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017-097508CRT5.full.pdf