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SKILLS STATION | By Doug Edenburn, NREMT-P Concussion Management Head injuries come with great risk. What should providers know about them? OVER THE YEARS we've learned a lot about concussion in athletics. Concussion has been linked to numerous chronic problems, including depression, dementia and Parkinson's disease.1 As a Substantial increases have been demonstrated in morbidity among victims who suffer multiple concussions in a short time.2 result, a number of sports organiza- tions have created or revised programs aimed at increasing awareness of what has proven a signifi cant problem. The research has prompted several medical organizations, including the National Athletic Trainers' Association (NATA) and American Academy of Neurology (AAN), to issue position statements and work toward developing guidelines regarding concussions in athletes.3,4 Health professionals specializing in sports medicine are well aware of this focus. Unfortunately, EMS providers may not be as familiar with current research and practices, even though such understanding would be a great benefi t to our practice. Concussion Essentials Concussion is classifi ed as a mild traumatic brain injury that inter- rupts normal brain function.5 Though concussed patients may present with Consider c-spine immobilization, especially in the unconscious patient, as forces that injure the head will often jeopardize the neck as well. school athletic contests, EMS providers will often be the fi rst healthcare provider an injured athlete encounters in many other situations (e.g., youth sports events). Further, although sports and recre- ation-related activities account for a substantial number of concussions, falls, motor-vehicle collisions and other mechanisms of injury commonly cause them too. As such, EMS professionals must be familiar with the recognition, "Patients who have suffered a recent concussion are at great risk for substantial complications from injury." More patients will just appear dazed, and symptoms may resolve rapidly. It is this subtle neurological presentation that makes recognition of concussion a challenge. While specially trained physicians and athletic trainers are likely to be present at higher-profi le professional, collegiate and even high loss of consciousness, the majority do not.6 22 FEBRUARY 2012 | EMSWORLD.com treatment and disposition of at-risk patients. Assessment of Head Injuries As always, assessment of any head- injured patient begins with consider- ation of the mechanism of injury. Did your patient sustain a blow to the head? If so, how exactly did it happen, and where was the impact? Was the patient using protective equipment? Keep in mind that the use of safety equipment does not preclude signifi cant injury. Next direct your attention to airway, breathing, circulation and level of consciousness.5 Consider c-spine immobilization, especially in the uncon- scious patient, as forces that injure the head will often jeopardize the neck as well.7 Early and aggressive airway management may be indicated, particu- larly with serious head injuries. Patients who experience a prolonged loss of consciousness should be trans- ported for evaluation without delay,5 as it is impossible to differentiate concus- sions from more severe injuries in these patients. Aim physical examina- tion at discovering associated injures, which should be managed promptly. Assess gross neurologic function and document the fi ndings. Once immediate threats to life have been ruled out, the conscious patient may be thoroughly assessed for concus- sion, primarily by evaluating their cognitive function. Photo by Nick Schuler/CAL-FIRE