Parent's and Coach's Guide to Concussion in Sport Australia Under 19 2024

The AIS lists these red flags. If any appears, the player needs immediate referral to the nearest emergency department:

• Neck pain
• Increasing confusion, agitation or irritability
• Repeated vomiting
• Seizure or convulsion
• Weakness or tingling/burning in the arms or legs
• Deteriorating conscious state
• Severe or increasing headache
• Unusual behavioural change
• Loss of vision or double vision
• Visible deformity of the skull
• Loss of consciousness

1. Apply first-aid principles. Suspect a neck injury if there is loss of consciousness, neck pain, or a mechanism that could cause spinal injury, and do not move the person without guidance from appropriately trained people.
2. Remove the player from sport immediately, with no return on that day (AIS decision tree). Take normal first aid precautions including neck protection.
3. Check for red flags. If any are present, send the player to the nearest emergency department. If none, refer to a healthcare practitioner as soon as practical.
4. Record the details for the treating practitioner: when the injury happened, how it happened, where on the body the player was hit, and what happened next (loss of consciousness, convulsions, amnesia, vomiting or confusion), plus any behaviour changes or memory loss.
5. Keep the player with a responsible adult.

The AIS decision tree for non-healthcare practitioners says athletes should NOT:

• Be left alone initially (at least for 3 hours). Worsening symptoms should lead to immediate medical attention.
• Be sent home by themselves. They need to be with a responsible adult.
• Drink alcohol, or use recreational drugs or drugs not prescribed by their healthcare practitioner.
• Drive a motor vehicle until cleared to do so by a healthcare practitioner.

The AIS also advises checking medications with a doctor, and avoiding aspirin, anti-inflammatories, sleeping tablets and sedating pain medications.

• First 24-48 hours: physical and mental rest. That includes time off school or work and limiting screens, reading and games.
• After 24-48 hours: light physical activity can begin if it does not worsen symptoms. Once symptoms clear, a staged return follows the Graded Return to Sport Framework for Community and Youth.
• School: school-age athletes can return to school or study after the initial rest if symptoms do not worsen. Schoolwork may need extra breaks, extra time or postponed exams. The AIS says return to school and learning should take priority before returning to sport.

For youth (under 19) and community sport, the AIS Concussion and Brain Health Position Statement 2024 sets:

• 14 days symptom-free (at rest) as the minimum stand-down before returning to contact training.
• A minimum of 21 days before returning to competitive contact.

Children and adolescents recover more slowly than adults, so a conservative approach applies. Symptoms usually resolve in under four weeks, and the AIS says a child or adolescent should be completely free of symptoms for at least 14 days before contact or collision activities.

For adults, the AIS coach and parent pages specify 24-48 hours of relative rest before a gradual return to activity.

The AIS Graded Return to Sport Framework for Community and Youth works like this:

• Start: recognise, remove from play and rest for 24-48 hours. No contact, and avoid the training environment temporarily.
• Then: resume activities of daily living (mild temporary symptoms are acceptable), then light aerobic exercise, with a graded return to school or work started alongside.
• No contact or high-risk activities at this point: the no-contact stages include stationary sport-specific skills with minimal head movements, a moderate walk or stationary bike, sport-specific skills involving head movements, resistance training, and sport-specific training drills, with cardiovascular activity increasing up to 80% of maximum heart rate and then up to 90%. "Moderate" means breathing heavily but able to maintain a short conversation.
• Each stage must last at least 24 hours, and symptoms must return to baseline before starting the next activity or stage.
• Persistent or worsening symptoms at any stage: refer to a healthcare provider for review.
• Checkpoint when symptom-free for at least 14 days: a healthcare practitioner reviews the athlete for clearance to return to contact and high-risk activities.
• After clearance: return to full contact training, then competition simulation, then competition. Return to competition is not before day 21 after the concussion, and the athlete must have remained symptom-free for at least 14 days.

A medical practitioner. Diagnosis is made by a medical practitioner using history, examination, cognitive and neurological assessment and balance testing, and clearance to return to sport must also come from a medical practitioner.

• If there is any doubt about whether a player is concussed, they "should not be allowed to return to sport until cleared by a medical practitioner".
• Parents, coaches and teachers only need to suspect concussion, not diagnose it.
• A school or club "concussion officer" coordinates concussion protocols but is not expected to diagnose.
• The Graded Return to Sport Framework for Community and Youth recommends a healthcare practitioner review at day 3-4 (including SCOAT6), and a healthcare practitioner review for clearance to return to contact and high-risk activities at the checkpoint after at least 14 symptom-free days.

The AIS sets different timeframes only for high-performance and professional athletes over 19 who have daily access to health care professionals: at least 10 days symptom-free before returning to contact activities, and they may be cleared earlier if their sport's concussion protocol allows.

Athletes under 19 do not get that earlier clearance. The Graded Return to Sport Framework for Community and Youth states that athletes aged under 19 years should NOT have access to the earlier clearance available in advanced care settings. For youth and community sport the stand-down periods are 14 days symptom-free before contact training and a minimum of 21 days before competitive contact.

According to the AIS concussion guidance for coaches and support staff, helmets, mouthguards and other protective wear offer little if any benefit in preventing concussion.