Concussion- When Can I Go Back In, Coach?

Now that football season is on again, we are seeing a lot of head injuries in the ED.  Usually the concussion is obvious- the player was knocked out, or obviously confused after the hit.  Last week though, I had a player come in for a wrist injury.  Then he told me, "by the way," that he had had a tackle the night before where afterward, he could not remember plays or even what his own position was!  Now he had a headache- was this a problem? I asked him why he did not tell his coach about his head injury.  He told me that the coach was "crazy" about kids slacking off and did not want to upset the coach and not be put back into play.  I told this teenager and his mom about the dangers of a second hit while concussed, where brain swelling and even death are real possibilities.  Fortunately for this player, his arm had a minor fracture and his season with this coach and his head injury was over anyway (fortunately, except of course for the broken arm). Concussions are being recognized by the NFL, the NCAA, LHSAA, and other sports as a big problem.  This year the NFL has much more strict rules about putting players in after a concussion.  Watching last Sunday's Saints game,  I noticed that after a head injury, players were being given neurological exams on the sidelines.  The Arizona quarterback, Max Hall,  was taken out for a time after a head injury, even though he wasn't knocked out (he looked pretty dazed though, I'm surprised they let him back in). What is a concussion?  A concussion is a head injury where you have certain symptoms afterward, like confusion, headache, nausea, poor concentration, and poor coordination.  In the next few days kids with concussions can have sleepiness, depression, and poor school performance.  Repeated concussions can lead to long term problems with thinking ability and mood.  Some people with a career of head injuries, like boxers and pro football players, can have syndromes like Traumatic Encephalopathy, which is akin to early Alzheimer's disease.  A kid with a second head injury while having concussion symptoms can end up in Intensive Care with serious brain swelling. As always, prevention is important.  Football equipment needs to be up-to-date.  Players need to be taught to tackle safely, where the player tackles with their arms and shoulders with heads up,  not "spearing' with their heads.  The new rule is "see what you are hitting."  Coaches and trainers need to know to watch for which players might have a concussion, do a quick sideline exam, and take out players with any concussion symptoms, no matter how minor.  No need to take a chance with tragedy!  Finally, players need to return to play only when they are free of concussion symptoms.  Then they need to return to play in a step-wise fashion.  This means that after a week of healing, they return only to running and calisthenics.  If they are still symptom-free, then they can go back to running plays in practice, without contact.  Then if that is okay, they can go back to full contact. Coaches, families, and players need to be aware of concussion.  Football, soccer, basketball, hockey (ice and field) and baseball and softball players, be careful!  Cheerleaders too- cheering is now considered a full contact sport, what with cheerleaders being stacked and thrown higher and higher into the air, and occasionally dropped back onto the ground.  There is no good reason to take chances with your brain.  I know this is Louisiana and we are talking about football, but again, isn't it only a game?