Guest Blog: Dazed and Confused

Guest Blog: Pastor IcePax
Emergency Medical Technician
WFTDA Risk Management Committee
WFTDA European Tournaments Medical Staffing Liaison

 

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Dazed and Confused (or … “so that’s what the ceiling looks like”)

Concussion… seemingly the latest “thing” in sports, every athlete in this sport knows someone who’s had one; but it can’t be THAT bad can it?
Let’s have a look;

How seriously do the UKRDA and WFTDA governing bodies take a skaters safety at a bout?

  • The current WFTDA guidelines are that any SINGLE positive indication on the concussion tests at a bout is enough for the medics to declare a skater unfit to skate for the rest of the game (NOT the half).
  • The Medical Team can stop a skater skating for ANY reason if they suspect that skater is not fit to skate under ANY circumstances (i.e. this doesn’t just apply to concussions).

IcePax – how did your concussion(s) happen?
Arty – During a game at Eastbourne Extreme, I turned and presented my chest to a jammer who dropped his shoulder and sprinted at me. Hitting me square in the solar plexus and driving up, he took me up and off my feet. I fell flat on my side, on concrete, and was knocked out by the impact.

IcePax – what can you remember of the event?
Arty – I remember being hit, being airborne for what felt like a long time and then the impact. It was dark, I think I could hear things still and I could feel my eyelids twitching. Then the medics were on me and they went through the whole C-spine isolation procedure. After a couple of minutes on the ground, I was up, wearing a collar and sat in the tent.

IcePax – What make of helmet were you wearing?
Arty – S1 Lifer G1 Visor (which was replaced after the impact)

IcePax – What happened next?
Arty – Well, I didn’t drive home that’s for sure! I was pretty woozy for the next 2-3 days. The immediate 12 hours I felt a bit drunk; dazed and would lose focus on what I was saying. I was pretty slow moving around and above all had a really stiff neck. Once the shock had worn off I was a bit frustrated, but as it had been a fun outdoor tournament I didn’t feel too bad about it. It’s a lot harder when it’s a game that really matters.

IcePax – How long were you advised recovery might take?
Arty – Based on the severity of the concussion, I was advised up to 6 weeks, although to follow up at A&E immediately if symptoms changed or increased in severity.

IcePax – How long did it actually take?
Arty – I was back to skating non-contact within 2, and back to full training after 4 weeks.

IcePax – What advice were you given to aid/promote your recovery?
Arty – Rest! For the neck, mobility and rehab exercises and lots of stretches. The main one was avoiding contact/impact for a good few weeks to allow the muscles in my neck and shoulders to recover.

IcePax – What support did you get from friends / family?
Arty – Love and support – I didn’t get any lectures which was very much appreciated; the focus was always on how I could get back to 100% as quickly as possible.

IcePax – What support / feedback did you get from your league?
Arty – The team were really supportive; I didn’t feel any pressure to return quickly other than from myself as I didn’t want to be ‘that injured skater’.

IcePax – Did you feel pressured from anyone (league/work/family) to return to normal activities?
Arty – No.

IcePax – How did you handle it?
Arty – I wanted to get back as soon as I could to prove to myself that it was no big deal and it wasn’t going to slow me down. The first one I shrugged off as an accident and that ‘these things happen’, but having had a couple of other less severe head injuries during game play it’s getting a bit harder to just shake it off. I’m working a lot more on prehab and conditioning now, Identifying the underlying issue and working to correct it rather than try to ignore it and hope it never happens again. I’m doing a lot more strength and mobility training along with cardio to make sure that I’m in the best condition I can be to play the game. This aim is to eliminate as many variables as possible. Expect the best, but plan for the worst. I’ve also upgraded to an ice hockey helmet following investigation of studies conducted around concussion prevention on the ice.

IcePax – What would you like to see done about raising concussion awareness in Derby?
Arty – I’d like to see a minimum standard of helmet across the board. I’ve seen a skater at another league suffer a concussion falling from standing because they were wearing a ‘fresh meat helmet’ that offered zero protection. Beyond that, it would be great to see leagues adopt standard return-to-skating practices rather than leaving the responsibility with the skater. Having been ‘that skater’ a few times now, I have returning sooner than I perhaps should have in the past as I’ve not wanted to miss out. It costs in the long run.

Interview with Arty McSly, all opinions expressed are his own and not an endorsement by any person or organization.

So what are the risks then?

By far the single biggest hidden risk that everyone forgets is “Second Impact Syndrome”. A skater has a concussion and gets back on skates too soon. They receive a big hit (doesn’t have to be to the head) and hit the deck, the impact of them hitting the floor is enough to jolt the brain enough to re-traumatise the earlier concussion that hasn’t healed, cerebral swelling occurs, brain herniation and death can occur. Second Impact Syndrome can occur with any two events involving head trauma. There is still a lot of research being done into this syndrome but it is definitely one to be aware of.
source: www.ncbi.nlm.nih.gov/pmc/articles/PMC2672291/

Are there any other risks?
Yes … repeated concussions can lead to a condition called Chronic Traumatic Encephalopathy. Chronic Traumatic Encephalopathy is particularly associated with contact sports, such as boxing or American football. Most of the available studies are based on ex-athletes. It was previously known as “punch drunk” syndrome and dementia pugilistica. However these terms are no longer used as it’s now known that the condition isn’t confined to ex-boxers.
source: www.nhs.uk/conditions/chronic-traumatic-encephalopathy/

The time has come to take head injuries seriously – if you see your team mates take a big hit and they “don’t feel right”, feel “weird” or don’t seem themselves (i.e. someone normally boisterous is suddenly quite, or vice versa) you need to be there for them. INSIST they get checked out by the medics, let the coaching staff know, if YOU are the coach, take the skater out of rotation until they’ve been checked out and have been cleared by the medics. If it happens at training, get them to sit the rest of it out, have someone sit with them and get them to get checked out at A&E. Remember, they may be confused, potentially even annoyed at the “fuss” and just want to be left alone but you need to support them, if they don’t want anyone to sit with them, then keep an eye on them from a distance but they NEED to be checked out. The sooner they start down the initial diagnosis path, the better.

But I’ve been to hospital before and they’ve just sent me away with painkillers – sure, they may have done – that time, but they would have also given you (or the person you were with) some advice or things to look for in the 24/48hrs post injury. If you’ve been checked out at hospital within the last year It’s important to mention that you’ve had a head injury before, again they MIGHT just send you home with the same advice … but they will also add to your notes, and check the results of any checks / physical tests they do closely. I know, I know you may be saying that “it’s ONLY a headache” and “your team needs you” but you know what? They need you to be fit and healthy, your family needs you. Don’t be a hero.

But I’m the coach and they are my star player – ask yourself this – is the sport worth dying for? Would you rather they played one game 50% fit? Or would you rather they were able to play lots of games 100% fit? Don’t pressure your skater to return to play, don’t write it off as only a little knock, it does NOT have to be contact to the head to cause a Concussion.

Let me re-iterate then:
The current WFTDA guidelines are that any SINGLE positive indication on the concussion tests at a bout is enough for the medics to declare a skater unfit to skate for the rest of the game. The Medical Team can stop a skater skating for ANY reason if they suspect that skater is not fit to skate under ANY circumstances (i.e. this doesn’t just apply to concussions).

The Referee has the ultimate authority when it comes to rules of gameplay, but the Medical Team have the ultimate authority when it comes to a skaters health and safety on track.

Pastor IcePax
Emergency Medical Technician
WFTDA Risk Management Committee
WFTDA European Tournaments Medical Staffing Liaison