Immediate Management of Suspected Concussion
Any person with signs or symptoms of concussion must be immediately removed from all activity (sports, play, work) and not allowed to return until evaluated by a healthcare professional. 1
Immediate Recognition and Removal from Activity
Remove the person from activity immediately upon suspecting concussion—this is a Class 1 recommendation with strong evidence showing that immediate removal is associated with approximately 3 fewer days missed from sport, shorter symptom duration, and less severe acute symptoms compared to delayed removal. 1, 2
Continuing activity after concussion onset significantly worsens outcomes and increases recovery time, making immediate cessation critical for preventing prolonged disability. 2
Emergency Activation Criteria
Activate emergency medical services (call 911) immediately if ANY of the following severe signs are present: 1
- Loss of consciousness
- Worsening headache
- Repeated vomiting
- Altered mental status or confusion
- Seizures
- Visual changes
- Swelling or deformities of the scalp
- Neurological deficits
These symptoms indicate potential life-threatening complications including epidural hematoma, subdural hematoma, open skull fracture, or brain edema requiring emergency hospital treatment. 1
Initial Assessment Without Scoring Systems
There is no validated single-stage concussion scoring system for first aid providers—assessment should be based on recognizing typical signs and symptoms rather than attempting to use complex scoring tools like the Glasgow Coma Scale, which requires specialized training. 1
Key Signs and Symptoms to Identify:
- Physical: Headache, nausea, impaired balance, visual disturbances 1
- Cognitive: Difficulties concentrating, confusion, memory problems 1
- Emotional: Emotional lability 1
- Other: Fatigue 1
Immediate On-Site Management
Keep the person still and at rest until professional evaluation can occur—avoid any physical or cognitive activities that could worsen the injury. 1
Do not allow return to activity the same day under any circumstances, even if symptoms appear to resolve—there is no same-day return to play for diagnosed or suspected concussion. 3
Monitor continuously for deteriorating physical or mental status while awaiting professional evaluation. 3
Critical Pitfalls to Avoid
Never use rigid cervical collars or long spine boards for routine spinal immobilization by first aid providers—these are not recommended and can cause harm. 1
Do not rely on loss of consciousness as a requirement for concussion diagnosis—most concussions occur without loss of consciousness. 1
Avoid administering NSAIDs or aspirin immediately after head injury due to theoretical risk of potentiating intracranial bleeding, though this remains unproven in sports concussion. 1
Post-Injury Vulnerability Period
The concussed brain enters a vulnerable metabolic state where a second impact before recovery can result in catastrophic worsening of injury—this postconcussive vulnerability period makes immediate activity cessation and protection from reinjury paramount. 3
Repeated concussions before full recovery lead to more severe symptoms, prolonged recovery, and potential long-term neurological sequelae including chronic cognitive dysfunction. 1, 3
Required Professional Follow-Up
All suspected concussions require evaluation by a healthcare provider trained in concussion management before any consideration of return to activities—this is non-negotiable regardless of symptom resolution. 1, 3
The evaluation should include assessment of cognitive function, balance testing, and determination of when graduated return to activity can safely begin. 3