Concussion Policy Update

In 2006, 13-year-old Zack Lystedt suffered multiple concussions in a football game, which resulted in serious long-term brain injuries. Zack’s case inspired patient advocates, who successfully lobbied the Washington State Legislature to adopt the nation’s first “concussion law” in 2009.

Since then, more than 40 state legislatures have enacted concussion laws. These laws typically require removing players who suffer suspected sports-related concussions from sports activities until a health care professional clears them to return to play. Presently these laws apply only to Most of these laws apply to school-sponsored sports programs and do not specifically apply to camps. In spite of this, these laws set an increased standard of care for camps with regard to concussion risk management.

The ACA and ACN have been leading the charge on educating camps on this issue. Please take the time to read the position statements and information that they provide.

All sources agree that potentially concussed players must be medically cleared before returning to play. You as the camp nurse should work with the camp physician, and directors to construct a clear policy for campers suffering from a potential concussion. Below is an example of a simple concussion policy. Feel free to use it as a starting point for your camp health service.

General Concussion Policy for Camp Environments

It is the policy of this camp that any camper involved in contact sports, who sustains a blow to the head, regardless of protective equipment, be removed from activities for 15 minutes, and evaluated, by a designated trained individual, for any of the following symptoms.

Headache

Nausea or vomiting

Double vision or other visual disturbances

Dizziness or balance problems

Drowsiness or odd behavior

Memory problems

If none of the above are present, the camper may return to activities. If any of the above are found the camper will immediately be escorted to the health center, for observation by the health staff. The camper will not be permitted to resume normal activities until cleared to do so by the camp doctor.

This is a very basic policy that has been added to the standing orders section of campfirenursing.com. The term designated individuals is used as many camps may have staff with advanced first aid training, who would be quite capable of doing a basic assessment of the listed symptoms. In the absence of staffers with advanced training, the nurse can provide education to selected trusted staff and allow them to clear uncomplicated injuries on their own, without interrupting activities.

Many camps and schools have chosen to use concussion assessment tools such as the sideline concussion assessment tool (SCAT) 3. These are excellent for data gathering, but in my opinion, they are not as useful from a camp nursing standpoint because anyone who is symptomatic requires physician evaluation anyway, so excessive assessment and data gathering from the nursing staff is superfluous and may result in conflicting documentation with the physician.

Physician evaluation and management of potential concussion will absolutely be a major hurdle for many camps, especially those without regular access to a physician. If your camp uses an alternative resource for definitive medical care such as an urgent care, or even the ED, then you should reach out to that source for guidelines on how to best accommodate the need for increased access and use of their resources to deal with potentially concussed campers.

I hope that this helps you start bringing your camp into line with the new standards of concussion management. Below are more in-depth resources around concussion assessment, management, and standards.

http://pediatrics.aappublications.org/content/126/3/597.full

http://www.acacamps.org/resource-library/articles/concussions-what-camps-can-learn-zachery-lystedt-law

http://www.acacamps.org/resource-library/camping-magazine/concussion-awareness-risk-management-more-headache

All opinions expressed are my own and to not represent those of my employer. Remember, anyone can pretend to be anyone on the internet, so please verify all information presented. NEVER take advice from strangers.