Sports medics and the teams that employ them must keep up to date with changing guidelines on concussion or risk high-profile legal claims.
Public awareness of the dangers of concussion for athletes is at an all-time high. This is largely thanks to Dr Bennet Omalu, who first described Chronic Traumatic Encephalopathy in American footballers with repeated head injuries. In recent years, massive class action lawsuits have been filed in the USA against the National Football League and the National Hockey League. In 2015, the issue reached the big screen when Will Smith starred as Dr Omalu in Concussion.
The Scottish approach
This month, Sport Scotland updated its 2015 guidelines for handling concussion injuries. The guidelines were a world first, with collaborative input from medics, sports bodies and the Scottish Government. They created a consistent policy applying to sports at every level.
The original guidelines focussed on ensuring that players rested after a suspected concussion. The update brings Scotland in line with the Berlin Consensus on Concussion and follows cutting-edge medical advice, encouraging rehabilitation of the brain rather than rest.
The guidance recommends a minimum rest period of 24-48 hours, followed by a staged return to normal daily activities and a graduated return to sport. If the athlete is "knocked out" or has a persistent headache, vomiting or unusual behaviour, they must also attend A&E. After two or more concussions in 12 months, an athlete must be assessed and managed by medics with experience in sports-related concussions.
Children and teenagers are a particular focus. The tragic death of schoolboy rugby player Ben Robinson in 2011 highlighted that young people are more vulnerable to complications after concussion as their brains have not fully matured. Ben's father Peter Robinson is a key sports concussion campaigner.
Guidelines in practice
Concussion in sport has major potential for litigation in the UK. Public awareness of the issue has greatly increased due to press coverage of the inquest into Ben Robinson's death. Advances in scientific understanding make this a fast-moving area of medicine. There have been murmurs of litigation from former rugby players forced to retire due to concussion injuries, but nothing has developed further as yet.
There is also the possibility of being charged with manslaughter or culpable homicide in a similar vein to the Bawa-Garba case, in which a junior paediatrician was successfully prosecuted for the death of a child under her care.
For healthcare practitioners involved in organised sport at any level, a working knowledge of these important new guidelines is crucial. Failure to implement them could result in irreversible brain injury. Sports medics must therefore ensure their practice is fully up to date, to provide the best care to patients and avoid the potential for very public legal claims. There is also the possibility of regulatory investigation. Failure to comply with the guidelines could find the regulator considering the standard of your practice in dealing with a concussion incident on the pitch.