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Certified athletic trainer and coach communication following suspected TBI


Approaching a coach about an athlete with a suspected TBI is not as stressful as it once was.  The reason for this is simple.  The NCAA has implemented a policy that an athlete diagnosed with a concussion is unable to return to competition for at least the remainder of that calendar day.  This policy gives authority for the certified athletic trainer to withhold the student-athlete from participation when a TBI is suspected. Assigning a grade to a concussion has undergone scrutiny.  Since each concussed athlete responds differently, it is becoming common to label the athlete as concussed or non-concussed, rather than assign a grade.  This eliminates the gray area that existed for deciding when to return an athlete back to competition/practice following a suspected TBI.

Prior to injury occurrence, the certified athletic trainer must develop rapport with the coach.  This process provides opportunity for gaining a mutual understanding of the procedures and protocols that designate the necessary actions for injury types.  Injury types can be categorized as non-emergent vs. emergent injuries and/or injuries that require immediate game/practice elimination vs. injuries that are subject to evaluation outcome prior to that athlete returning to game/practice setting.  Following this step, the coach should have an understanding of the injury type category that TBI’s are included within and it should not be a surprise for them that their athlete will not, at minimum, return to that day’s competition following a suspected TBI.

Primarily, the responsibility of the certified athletic trainer is to ensure the safety of the athletes.  Approaching a coach is simply the certified athletic trainer being an advocate for the injured athlete.  Their concern is the health of the athlete rather than the outcome of the game.  The coach should be approached with confidence.  Regardless of the coach’s response, the health of the athlete is priority and the coaches pleas to return the athlete with a suspected TBI back to play should be denied.  Unfortunately, difficulty ensues.  Coaches often rely on emotion and instinct rather than research or science for decision making.  Their career is determined by wins and losses.  These variables may cause the coach to pressure the certified athletic trainer into allowing the athlete to return.  Adding to this pressure, especially within the University setting, some certified athletic trainers are hired directly by the coach, report directly to the coach, or the coach has influence with hiring and firing decisions.  This may force the certified athletic trainer to choose between the well-being of the athlete or their job.  However, if litigation arises, the certified athletic trainer and team physician are usually questioned, not the coach.

When injuries occur, coaches are often seeking a brief statement that provides reasoning for the athlete to be excluded from play.  For instance, the certified athletic trainer may respond, “Based on my assessment, the athlete has signs and symptoms of a TBI and any further head trauma may cause further harm such as secondary impact syndrome which can be catastrophic.”  However, if a coach wants to be briefed on the athletes condition, they should be made aware of the athletes symptoms (somatic, cognitive and/or emotional), physical signs (loss of consciousness, amnesia), behavioral changes (irritability), cognitive impairment (slowed reaction time), and results of the sideline evaluation test (SCAT3, SAC). The goal of this briefing is to formulate an understanding that the athlete with a suspected TBI is at further risk for harm if returned to competition.

This article was published with permission from the author, Mr. Richard Hardy.


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