Loss of Consciousness Following a Head Impact

Situation #2 - 50-50 Collision

You just witnessed a horrible collision between one of your players and an opponent - a direct head to head impact as they were both trying to head the same ball. They both missed the ball, but hit each other hard. The opponent is walking away, but your player is on the ground, not moving at all. You rush onto the field, but find him totally non-responsive initially. You call out for a doctor and the player suddenly lifts his head, opens his eyes, and tries to focus on his surroundings. When you ask him to name the opposing team he can't remember. He was unconscious for probably about a minute. What should you do?

You take him off the field as soon as he can walk with assistance, and arrange for a doctor to come to the field as quickly as possible to examine him.

Good job! While his loss of consciousness may not prove his injury is serious, the entire situation - obvious hard impact, loss of consciousness, loss of memory - taken together suggests that his injury may be quite serious and no chances should be taken. If his symptoms seem to worsen while you're waiting for a doctor, call 911 immediately and get him into an ambulance.

The fact that he was knocked out means this was a bad concussion, and he should be taken by ambulance to the nearest hospital.

Not necessarily. It was long believed that if a person wasn't knocked out, he didn't have a serious concussion; if he was knocked out, it was serious, and the length of time he was out indicated whether is was just plain serious or really, really serious. But recent studies have shown that loss of consciousness may not be a reliable symptom of severity. In some cases a player who never loses consciousness may have more serious cognitive deficits for a longer period than someone who was knocked out for a minute or so.

The player jumps up and seems to be fine physically, but he doesn't remember the collision or anything that happened earlier in the game. Since he's acting okay, he must not be badly hurt; it's natural for him not to remember some things, and his memory will come back within a few minutes.

Not necessarily. When it was discovered that loss of consciousness is not well correlated to concussion severity, it was also found that amnesia is more strongly associated with severity. A player who is knocked out and wakes up with full memory is probably not as seriously injured as a player who wasn't knocked out but doesn't remember the opponent or the score of the game.

If the player goes into seizures while unconscious that must mean he has serious and permanent brain damage.

Once again, not necessarily. Seizures after a head impact on the soccer field are dramatically frightening, but fortunately they don't occur very often, and may not be an indicator of the severity of the injury. No one is sure why seizures occur in a few head impacts but not in others. The good news is that, despite the visual impact, head impacts with seizures are generally no more serious than impacts without seizures.

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