Identifying Concussions:

 Step 1: Look for Red Flags

If any of these are present seek emergency medical care:

• Loss of consciousness

• Seizures or convulsions

• Vomiting

• Severe or worsening headache

• Weakness or numbness in limbs

Step 3: Glasgow Coma Scale (GCS)

Step-by-Step Instructions to Use the Glasgow Coma Scale

1. Prepare for Assessment:

• Record the time and date of the assessment.

• Ensure the patient is in a safe environment for evaluation.

2. Evaluate the Patient's Responses:

A. Eye Opening Response (E) - ask “Can you open your eyes”

• No eye opening = 1 point

• Opens eyes to pain = 2 points

• Opens eyes to speech = 3 points

• Opens eyes spontaneously = 4 points

B. Verbal Response (V) - ask “What is your name”

• No verbal response = 1 point

• Incomprehensible sounds = 2 points

• Inappropriate words = 3 points

• Confused but able to respond = 4 points

• Oriented and coherent = 5 points

C. Motor Response (M) - ask “can you grasp and release my fingers with your hand, then stick out your tongue”, if non responsive gently squeeze their trapezius muscle for 3s and look for their response.

• No motor response = 1 point

• Extension to pain (decerebrate) = 2 points

• Abnormal flexion to pain (decorticate) = 3 points

• Flexion/withdrawal to pain = 4 points

• Localizes pain = 5 points

• Obeys commands = 6 points

3. Calculate the Total GCS Score:

• Add the scores for Eye Response (E), Verbal Response (V), and Motor Response (M).

• Total score range: 3 to 15.

4. Interpret the Score:

• Score <15: Seek immediate medical attention (this is a red flag).

• Score ≥15: Proceed to the next step in the concussion evaluation protocol.

Step 5: Coordination and Vision Screening

1. Finger-to-Nose Test: Ask the athlete to extend their arm and touch their nose 5 times with both eyes open and closed. Test both left and right sides.

2. Ocular Motor Test: Have them move their eyes up, down, and side to side while keeping their head still. Watch for:

• Double vision

• Jerky or abnormal eye movements

If test is positive, seek medical advice and concussion support
Otherwise proceed to the next step in the concussion evaluation protocol.

Step 4: Assess for Neck Injuries

Ask if the athlete feels neck pain or tenderness:

• If neck pain or tenderness is present, or loss of neck motion: Immobilise the neck and call an ambulance.

• If no neck issues: Proceed to the next step.

Step 6: Maddock’s Questions

 Ask the following questions to assess orientation and memory, tailor this to your situation.

1. Where are we today?

2. What period/half is it now?

3. Who scored last in this match?

4. What team did we play last week/game?

5. Did your team win the last game?

If any questions are incorrect, seek medical advice and concussion support

If all answers are correct, proceed to the next step.

Step 7: Symptom severity score of the SCAT6

to rule in a concussion, look for any increase of two or more symptoms compared to usual. 

Symptoms can include:

• Physical Symptoms:

  • Headaches

  • Pressure in head

  • Neck pain

  • Nausea or vomiting

  • Dizziness

  • Blurred vision

  • Balance problems

  • Sensitivity to light

  • Sensitivity to noise

• Cognitive Symptoms:

  • Feeling slowed down

  • Feeling like "in a fog"

  • "Don’t feel right"

  • Difficulty concentrating

  • Difficulty remembering

• Emotional Symptoms:

  • More emotional

  • Irritability

  • Sadness

  • Nervous or anxious

• Energy Levels and Sleep:

  • Fatigue or low energy

  • Confusion

  • Drowsiness

  • Trouble falling asleep (if applicable)

Why Early Evaluation Matters

The prognosis for concussion is directly related to the time taken to see a healthcare practitioner, with earlier evaluation and treatment associated with better outcomes. Delayed clinical evaluation has been linked to more persistent and severe concussion symptoms in up to 40% of cases when left untreated.

Don’t wait to take action—your quick response could make a significant difference in recovery and long-term health.