Adults in community sport and children aged 19 and under will be sidelined for a minimum of 21 days if they suffer a sport-related concussion, under new guidelines released by the Australian Institute of Sport.
The Youth and Community Sport guidelines, which effectively cover everyone in sport outside elite levels, have been created to provide “simplicity and clarity” about the widely varied protocols used in Australian sport for a safe return to play after a concussion.
While minimum post-concussion timelines have previously been applied to children, the new guidelines also include mandatory stand-down protocols for adults in community sport for the first time. As part of an updated AIS Concussion Health Position Statement, adults in community sport and kids will be told to stand down for at least three weeks, and possibly longer if concussion symptoms linger.
The AIS advice for children aged 19 and under to not resume contact training until they’ve been symptom-free for 14 days will also apply to adults in community sport. It mirrors protocols established in the UK last year, and the AIS worked with British and New Zealand counterparts to align their positions.
The changes come in response to last year’s Senate inquiry into concussion and head trauma in contact sports, from which a recommendation was made to “develop return to play protocols, adaptable across all sports, for both children and adults that have incurred a concussion or suffered a head trauma”.
With no regulatory power, the AIS advice remains just that, but the national bodies of more than 30 sports have already indicated they will adopt the new guidelines. Sports currently have a wide array of stand-down protocols, mostly set around 12 days.
Concussion protocols vary from sport to sport.Credit: Getty, NRL Photos
“There are two groups where we need to exercise an abundance of caution in relation to concussion, and that is people who are growing and have developing brains, and those adults who are playing in a community setting where they don’t have good access to a healthcare practitioner or support,” AIS chief medical officer Dr David Hughes said.
“In those cases, we need to err on the side of caution. We need to simplify what happens at the youth and community setting. The concern is only amplified when there is inconsistency of message, or lack of clarity. At the moment, we have a situation where a lot of sports have different rules and guidelines around return to sport, after concussion.
“What we are really striving for there is clarity of message and consistency of message. Teachers and coaches and officials are desperately trying to do the right thing by their charges but it gets very confusing. That only feeds into confusion and anxiety around concussion.”
The updated AIS guidelines also cover management of concussion and symptoms in para-athletes and female athletes. Hughes said “education is key” in ensuring a safe return to school, work and sport.
AFL chief medical officer Michael Makdissi, beside the league’s CEO Andrew Dillon, answering questions earlier this year at the Senate’s concussion inquiry.Credit: Jason South
“We want to decrease those risk factors by making sure no one returns to sport prematurely. Really, what we are aiming to do is erring on the side of caution and, if someone is unlucky enough to have concussion, we want to make sure it is a one-off for them,” Hughes said.
The AIS advice also calls each school and club to appoint a “concussion officer”, who – in the mould of a fire warden in a workplace – responds and records incidents, ensures a medical expert is consulted and then steers each individual’s return-to-play timeline.
But how concussion education and mandatory stand-down periods are enforced remains a big question. The Senate inquiry recommended the Australian government consider its options to make concussion protocols “binding”, and not left to sports to self-regulate.
Dr Alan Pearce, one of Australia’s foremost concussion experts, welcomed the changes as “a good step in the right direction” but said children stand-downs should be longer than adults, and that online concussion education should be compulsory in sport, similar to a working-with-children check. He cited laws in Scotland and Canada brought in after children died playing sport.
“In both cases what they’re doing is mandating in law, and it is what we should be doing here, is having mandatory concussion education for players, trainers and coaches on a yearly basis. We can’t risk someone dying on the field because of a lack of awareness of what to do,” Pearce said.
Hughes said: “I would love to see that, I have to say. We are not a regulatory organisation, so we can’t tell people what to do, but we are strongly encouraging all sports to get on board.”
He added the AIS had vast amounts of educational resources on concussion awareness available for all levels of participants in sport, including a new interactive module designed for non-health practitioners.
Hughes said opting for a three-week stand-down for adults in community sport “was a balancing act”.
“There is always a tension between wanting to have safe times provided but not drive concussion reporting underground – if you make the return to sport rules too onerous, you run that risk,” he said.
“If you tried to push it out much further, you would start to get people not reporting and seeking medical input, that’s the worst outcome.”
