International Swim Coaches Association

Concussion Policy

Concussion is a well-recognized injury that impacts many athletes and teams.

It is important that swimmers, players, parents, coaches and other officials are aware of this condition. They should be on the look-out for symptoms and signs that could indicate concussion. All sports coaches and guardians need to be practiced in the way concussions should be managed.

Fortunately, concussions are not nearly as common in the aquatic environment as they are in other sports, particularly football, LAX, rugby and soccer. Nevertheless, cases have occurred and, no doubt, will continue to happen, due to the nature of sports. When concussions and/or hits do occur, these cases need to be recognized and the individual must be appropriately looked after.

This document is prepared specifically for aquatic leaders and the general public and is not a medical document.

CONCUSSION FACTS

• Concussion is a form of brain injury.
• All concussions should be considered serious.
• Concussion results in a brain function disturbance.
• Children and adolescents should be treated differently than adults, as young people:
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  1.  are more prone to concussion,
  2. take longer time to recover,
  3. have more significant memory and mental processing problems,
  4. are at greater risk of rare and dangerous neurological complications, caused by a single or second impact.

Children and adolescents should therefore be treated more conservatively than adults.

• Concussion usually follows a head collision.
• Concussion can also occur with a collision not involving the head.
• Symptoms usually develop quickly, often within 1-2 hours. Sometimes there is a delay, 24-48 hours after a collision.
• Most concussions occur without the player being “knocked out,” i.e., losing consciousness.
• However, if a player is “knocked out,” then they are concussed.
• Players with suspected or recognized concussion must immediately be removed from all physical activities, including the pool.
• A individual suspected of concussion cannot return to play or training on the same day.
• Only a medical doctor can certify a fit-to-return status.
• Concussions that are not recognized or ignored can prove fatal.
• Most individuals with concussions recover with physical and mental rest.

The Six “R’’ Management Plan

The management of concussion involves sequentially following steps. Each must be followed and completed before moving to the next step.

• RECOGNIZE

• REMOVE

• REFER

• REST

• RECOVER

• RETURN

RECOGNIZE

Concussions must be suspected or recognized if a player has any of the following signs, symptoms or fails to answer any of the memory questions after a head or body collision.

REMOVE

• Any person with a suspected or recognized concussion must be removed from the pool immediately.
• The individual must not take further part in any training or games (including other sports activities) on this day.
• Any player with a head injury may also have a neck injury.

RECOGNISE AND REMOVE.

IF IN DOUBT, SIT THEM OUT.

REFER

• All athletes with suspected or recognized concussion must be referred to a medical doctor or emergency department as soon as possible.
• This referral must happen even if symptoms or signs have disappeared.
• Ideally, the medical doctor who reviews the player should have experience in the diagnosis and management of sports concussion.
• The player must at all times:

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  1.  Be in the care of a responsible adult.
  2. Do not consume alcohol.
  3. Do not drive a motor vehicle.

If any of the following warning signs of head injury appear, the player must be taken to the closest hospital Emergency Department immediately or a responsible adult must call an ambulance (000):

Warning signs

• Severe neck pain.
• Deteriorating consciousness.
• Increasing confusion or irritability.
• Worsening headache.
• Vomiting more than once.
• Unusual or uncharacteristic behavior.
• Seizure (fitting).
• Double vision.
• Weakness or tingling or burning in arms or legs.

REST

• REST IS THE CORNERSTONE OF CONCUSSION MANAGEMENT.
• THE Athlete SHOULD REST COMPLETELY UNTIL ALL SYMPTOMS and SIGNS OF CONCUSSION HAVE DISAPPEARED.

Complete rest means:

• Resting quietly at home until symptoms and signs are settled.
• Limit any physical exercise to short periods of low level activities.
• The brain needs to rest. Limit any tasks that require prolonged or focused memory and/or concentration.
• Avoid the watching of TV, use of mobile devices, electronic games, computers and phones as these aggravate symptoms.

How long should the individual rest completely?

• Athletes must rest until all their signs and symptoms have disappeared, AND they have stopped all medication required for treatment for their concussion symptoms (e.g. pain killers for headaches).
• The minimum complete rest period is 24 hours for adults.
• Children and adolescents need a longer complete rest period.
• The required period of complete rest varies from person to person. So, a medical doctor is the one to specify the minimum time of complete rest for each case.

RECOVER

• Once symptoms and signs are settled and medications are stopped, the individual then returns to activities of normal daily living (school, study or work).
• The individual must not perform any exercise or any organized sport.
• If any symptoms re-occur during recovery, the athlete needs additional complete-rest time.
• If symptoms re-occur, the individual should be reviewed by his or her medical doctor.

RETURN

• Exercise can only start after the individual has returned to activities of normal daily living without signs or symptoms of concussion and does not require medication for any symptoms.
• The best way to return to sport is to follow a gradual re-introduction of exercise in a stepwise progression known as a graduated return to play program (GRTP) as per the following example for a water-polo player.

Return to exercise (GRTP Stage 1 – 4)

• Stage 1 is the complete rest and recovery period.
• A player should be cleared by a medical doctor to commence light exercise (Stage 2).
• A player can only proceed to the next stage of the GRTP if they have no signs or symptoms of concussion at the time of exercise, later that day (after exercise) and on waking the following day. The minimum time between stages is 24 hours, although children and adolescents may require a longer period of time between stages.
• If there is a recurrence of symptoms at any time during the GRTP the player must:

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  1.  Rest for a minimum of 24 hours until all symptoms and signs have settled.
  2. Return to the previous stage at which they had no symptoms.
  3. Recommence the progression of the GRTP.

If a player has a recurrence of severe symptoms (e.g. requiring them to miss school, study or work) or repeatedly (more than once) during the GRTP, or if the recurrent symptoms are prolonged (more than 24 hours), the player should be reviewed by their medical doctor.

Return to contact training (GRTP Stage 5)

• The player must have a medical certificate from a medical doctor to start full training (Stage 5).
• This certificate must be given to the club or school sport master.
• Players 18 years and under cannot return to full training (Stage 5) or playing for at least 2 weeks (14 days) after all symptoms and signs have disappeared.

This restriction to return to contact training and playing applies to all players aged 18 years and under including those playing adult water polo.

Return to play (GRTP Stage 6)

A player should only return to play when they have fully recovered from concussion. This means the player must:

• Not have any signs or symptoms of concussion at rest or in normal daily activities (school, study or work).
• Have successfully completed the GRTP without any symptoms or signs of concussion (during or after full training).

Multiple and more complex concussions

This guidance applies only to players who have suffered their first concussion in a 12-month period. The guidance does not apply to players with potentially more complex injuries. Those players must see a medical doctor who is experienced in sports concussion management:

• When two or more concussions occur inside a 12-month span.
• Multiple concussions throughout their playing career.
• Concussions occurring with less collision force.
• Concussion symptoms lasting longer than expected, i.e., a few days.

All ISCA coaches are required to take the online, no charge, CDC Concussion Training Course called Head’s Up. 

• Coaches can submit the completed certificate for the course into the learning management system at Read.SwimISCA.org.