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These guidelines are intended for implementation by Athletic Trainers, Athletic Directors and Coaches. Diagnosis of concussion and return to play decisions should be made by licensed physicians only. First aid should only be administered by trained individuals.

It is essential that all individuals who have an on-field injury management role in their sport have formal training and certification in both first aid and Advanced Trauma Life Support (ATLS), Trauma Evaluation and Management (TEAM) or equivalent.

Important points

Everyone should be aware of the following important points when evaluating athletes in the immediate post-concussion period:

• An athlete does not need to lose consciousness to be concussed.
• If the athlete is unconscious, assume a spinal injury has occurred until proven otherwise.
• If an athlete reports any symptoms, assume they have been concussed until proven otherwise.
• The immediate priorities are the basic principles of first aid: Danger, Response, Airway, Breathing & Circulation.
• Helmet removal should only be performed by appropriately trained individuals.

First aid

Immediately following any sports injury, the major priorities are the basic principles of first aid. These are:

D: Danger: Ensure that there are no immediate environmental dangers which may potentially injure the patient or treatment team. This may require the stopping of play.

R: Response: Is the patient conscious? Can he/she talk?

A: Airway: Ensure a clear and unobstructed airway. Removing any mouth guard or dental device which may be present.

B: Breathing: Ensure the patient is breathing adequately.

C: Circulation: Ensure adequate circulation.

Removal from the field

Once the athlete is stabilized, he or she should be removed from the field. Before moving, careful assessment for the presence of a cervical spine or other injury is necessary. If the athlete is unconscious, then a cervical injury should be assumed until proven otherwise. In alert athletes, neck bracing and transport on a suitable spinal frame is required if the athlete complains of neck pain, has evidence of neck tenderness or deformity or has neurological signs that suggest a spinal injury. Removal of helmets or other head protectors should only be performed by individuals with appropriate training.