The most recent concussion I handled was my worst nightmare right before my eyes. Some of the scariest moments in athletic training are those when kids are returning from an injury. On the inside, you are scared that they will re-injure, that what you have provided was not enough, that you could have done something more to protect them. All of that is amplified by about ten-fold with a player returning from a concussion.
This player was one of our first concussions of the season. He sustained it September 13th and was not allowed to return with MD clearance until September 27th. He went through the graded return to play. He passed that, and then passed his ImPACT test with flying colors. He participated in lower level games and one varsity game prior to last week. Each game he was debriefed by one of us in the athletic training room.
However, this past Friday he sustained another hard shot to the head. I saw it, and cringed a bit as he was on the ground, but he popped right back up. As he began his way to the bench from across the field, he grabbed his head and I knew something was wrong.
I let my student perform the evaluation on him. He wanted back in the game, saying he was fine. Although, you could tell that the weeks of drilling him about the symptoms and dangers of concussions were beginning to seep through. He was more truthful and compliant with us, so I focused my attention to the game on the field, while my student watched over him. As I was trying to find a ride for him (other than the bus) to get home, I was beckoned by my student. She reported to me that his condition was deteriorating, as she was telling me this he started to close his eyes and sway badly.
Without thought I bolted across the field, while teams were in the huddle, to inform the home athletic trainer I need the ambulance, “NOW”. I sprinted back across the field, this time the officials blow the whistle, and our coach asked what was going on, I told him to clear the field and let the ambulance on our sidelines.
Keeping him coherent was a task, all I could think was “2nd Impact Syndrome“…All I could think was “let this not happen”… All I could think was “stay calm”… All I could think was “do your job”… All I could think was “he is going to be OK”. As the ambulance arrived the crew deferred to me and immediately placed him on the stretcher, got him in the ambulance, and they left with lights and sirens to the local hospital. His parents were not there, so I sent my student in the ambulance with him so I could still perform the role as athletic trainer for the remainder of the game. Thankfully, the only injury was a rolled ankle in the waning minutes.
After the final horn, I took care of all the post-game stuff and checked my phone for an update. It had been about 25 minutes since the player was transported. I received a text form a student that read, “just arrived at hospital, they were having a difficult time keeping him aroused.” I debriefed the head coach and he sent the team off on the bus home, and stayed with me as we headed to the hospital. The administration had contacted parents, who were 1.5 hours out, but on the way.
At the hospital, only his aunt, uncle, the coach, my student, and myself there for him, but we were not allowed in the room, per HIPAA rules. In fact, the only update we received was watching him roll by on a stretcher from CT scan, and he was not looking good. He was pale, being administered oxygen, strapped to a spine board, with his eyes closed. For the first time I allowed myself to be worried. Not knowing his prognosis was the worst. After retrieving my student’s car from the school, the hospital staff informed us they were transferring him to a bigger hospital, as his condition was not improving.
Thankfully the bigger facility was the hospital I work at, so I could get access to him until his parents arrived. I think I needed to see him more than he needed to see me. As we arrived I used my badge to get in the ER and find him, eyes open and a huge smile greets me. All I could think was “PHEW.” He just wanted off the board, he just wanted to hear he was going to be OK. He wanted to know if he was going to be like the kid I had posted on my blog (video was removed), that had permanent damage. I could not give those answers, all I could tell him is that I was there and that he was in GREAT care and hold his hand, which he squeezed hard as tears streamed down his face.
After some comforting I found the attending physician, a friend of mine, who filled me in. His CT was clear, but the doctor was concerned about his reaction, and his previous concussion. Since he was stable, I asked that we remove him from the board and we could talk more. By this time, his family had arrived and were told he was going to be OK. The efforts had not been for naught…what we did was right. Immediate care, immediate transport and immediate imaging of the brain to rule out 2nd Impact Syndrome.
In our conversation, the doctor was given the history from someone who knew exactly what has happened to the player. We discussed possible interventions to concussions in the emergency room. We talked about the increase of concussions recently. We talked about a presentation to the medical staff of the ER about concussions. A very enlightening conversation for both parties, one of which we will deal with at a future date. Although this athlete was concussed for the second time, it was as if it was his first in terms of the body’s reaction. This was only due to the fact that he was allowed to “heal” over the time he was previously out. Had that not occurred there is a great possibility that we would be looking a different end to this story. I felt relief in the fact that all the preparation and education had worked and worked well. And this relief that I felt dwarfed the feeling of panic I had about two hours prior.
He was OK! Shaken up, scared, and worried about his athletic future, but he was going to be fine.
And so was I.