'Am I ready to return?': Reality of concussion protocols hit hard

Newyln footballer Leo Bell was concussed in last weekend's reserves match against Buninyong in a tackle where his head hit the turf. After leaving the ground, he spent three hours in the waiting room in urgent care, before being seen to by a GP.

After a quick check up, he was given the all clear, however he continued to feel flat for a few days afterwards.

"I experienced a brief loss of consciousness, mild headache, blurred vision, and was in a state of fogginess," he told The Courier.

"My recovery was relatively quick, I was able to stand up and immediately realise what had happened before being assisted from the field."

Bell is full of praise for how the club and medical staff, many volunteers, handled his case, saying it was clear they was aware of the new local protocols.

"Previously, I would have considered just taking a breather to collect myself before putting my hand up to get back out there," he said.

"However, this time there appeared to be a newfound level of awareness and acceptance that, if in doubt - I should sit it out."

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"My trainers were readily prepared with the concussion assessment form to review the incident and assess the severity of my symptoms. Despite my relatively quick recovery, I could hear the anxiety in the trainers' voice - 'loss of consciousness - tick' - that's considered a red flag and automatic referral to medical services."

And while he has equal praise for the overworked medical staff who saw him later in the day in urgent care, he has concerns about how ongoing assistance will work for those who may require it after more severe concussions.

"It was reassuring to know that I didn't have any signs of skull fracture or severe brain damage requiring further care," he said. "(But) the doctor medically cleared me to say my symptoms of concussion had been resolved.

"I pulled out the concussion management form and presented it to the doctor to determine if he had any awareness of such a protocol. I could hear more urgent matters grabbing his attention in the next bay. I was assessed, triaged, and free to go. Am I ready to return?"

The return to play protocol has four critical stages following concussion; 1. A brief period of relative rest (24-48 hours) 2. A period of recovery, 3. A graded loading program (with medical clearance required before full contact training, and 4. Unrestricted return to play.

Players cannot enter stage 3 until signs and symptoms of concussion have been fully resolved for at least 24 hours, at rest and during intense physical exertion.

The earliest a player may return is on the 21^st day following the concussion if they have recovered according to the protocols and are medically cleared. For players aged 18 and under, it may take up to four weeks or longer.

Players with symptoms lasting four or more weeks, with two or more concussions in the same season, or three concussions within 12 months, should be managed more conservatively and with consultation from a doctor with expertise in the management of concussion.

Later in the day, the senior match between Newlyn and Buninyong was abandoned after Buninyong's Tyler Mookhoek was hospitalised. In a separate game, two Beaufort players, Noah Leckie and Tom Murphy, were both injured after they accidentally collided with each other, and these were just the ones that were reported.

Bell will return to a GP to gain a medical clearance via the protocols within the next two weeks, however there is no guarantee he will see either the same practitioner or a sports injury expert.

He believes a specialised concussion service would be a beneficial way to get clearer results.

"The new concussion management protocol heaps a lot of shared responsibility onto volunteer club members, coaches, and doctors to be across how players are feeling and their preparedness to return," he said.

"But are they ready for that? Perhaps it's time for a specialised concussion service. A service that can provide the expertise required to manage concussion from day of injury, through to graded return to play and full recovery.

"The protocols are fine for something in round one, but there's going to be a lot of pressure placed on clubs, volunteers and doctors later in the season if finals or big games are on the line."

For Bell, who is completing a PhD in exercise physiology at Federation University, said at 34, it is his third minor concussion received while playing football. He believes that most footballers who have played for a significant length of time would have conservatively received at least two in their career.

"Then they are some unlucky one who have had many and that's a real concern," he said.

"The concussion guidelines are new and the science behind them is evolving. Like any injury, there is a personal responsibility to adhere to the care plan and ensure a full recovery," he said.