What is the appropriate management for a football player who has been struck by another player?

Management of a Football Player Struck by Another Player

When a football player is struck by another player, immediate assessment for concussion or more severe injury is mandatory, with removal from play if ANY symptoms or signs of concussion are present.

Initial Assessment

Primary Survey

• Check for responsiveness and consciousness
• If unresponsive, treat as potential cardiac arrest until proven otherwise 1
• Any player who collapses without contact with another player or obstacle should be regarded as being in SCA 1

For Responsive Players

1. Assess for signs and symptoms of concussion:

   • Confusion or disorientation
   • Memory problems
   • Balance problems
   • Headache
   • Visual disturbances
   • Nausea or vomiting
   • Dizziness
   • Sensitivity to light or noise

2. Perform targeted neurological examination:

   • Mental status assessment
   • Cranial nerve function
   • Motor and sensory function
   • Balance testing
   • Coordination testing

Management Protocol

If Concussion is Suspected

1. Immediate removal from play - "When in doubt, sit them out!" 1
2. Do not allow return to the current game or practice
3. Do not leave the player alone; monitor regularly for deterioration
4. Arrange medical evaluation after the injury
5. Return to play must follow a medically supervised stepwise process 1

If Cardiac Arrest is Suspected

1. Initiate high-quality CPR immediately with chest compressions 1, 2
2. Apply AED/defibrillator as soon as possible 1
3. For shockable rhythm: deliver one shock per 2-minute cycle of CPR (minimum of three shocks on field) 1
4. For non-shockable rhythm: continue high-quality CPR and obtain IV/IO access 1
5. Transfer to hospital when safe and appropriate 1

For Other Injuries

• Assess for fractures, dislocations, sprains, and contusions
• Joint sprains (30%), fractures (16%), and muscle strains (15%) are the most common severe injuries in football 3
• Knee (29%) and ankle (19%) injuries are most prevalent 3

Return to Play Protocol

For Concussion

Return to play follows a stepwise process 1:

1. No activity, complete rest until asymptomatic
2. Light aerobic exercise (walking, swimming, stationary cycling)
3. Sport-specific training
4. Non-contact training drills
5. Full-contact practice after medical clearance
6. Return to competition

For Other Injuries

Return to play criteria include 4:

• Full range of motion
• Normal strength
• Normal neurological evaluation
• No joint swelling or instability
• Ability to run and sustain contact without pain
• No intake of pain medication

Prevention Strategies

1. Enforce rules against using equipment as weapons 1
2. Prohibit deliberately inflicting injury on another player 1
3. Ensure all protective equipment meets safety standards 1
4. Implement regular emergency action plan rehearsals 1
5. Provide annual education about catastrophic injuries to coaches, players, and staff 1

Common Pitfalls to Avoid

1. Mistaking seizure-like activity for a seizure - Brief seizure-like movements occur in over 50% of athletes with SCA 1
2. Inaccurate assessment of pulse or respirations - Agonal gasping can be misinterpreted as normal breathing 1
3. Delayed recognition of SCA - This can lead to critical delays in resuscitation 1
4. Premature return to play - This increases risk of second impact syndrome or prolonged recovery 1
5. Inadequate monitoring - Players with concussion should not be left alone 1

Remember that player safety must always be prioritized over competitive considerations. The consequences of mismanaging these injuries can be catastrophic, including permanent disability or death.