How Australia's top contact sports manage concussion

In 1994, concussion was (in)famously referred to as a journalist issue by then National Football League (NFL) Commissioner Paul Tagliabue, who said 

"… concussions, I think is one of these pack journalism issues, frankly. There is no increase in concussions, the number is relatively small … the problem is a journalist issue"[1]. 

A class action for lawsuit brought by at least 5,000 NFL retired players was finalised in April 2015, and despite the NFL denying any linkage between the risks associated with football and brain trauma, the players were successful in securing a settlement which is reported to have cost the NFL at least $1 billion over a 65-year period[2]. The players' case relying on what they said was a failure to put adequate protocols in place to protect players.[3]

In Australia, if you were to mention concussion to a group of parents at a Saturday morning football match even ten years ago, and there would have been little, if any, reaction. Fast forward to 2017, and concussion is not only a feature of discussion at a grassroots level, but is now a focus point of player welfare elite level. The turning point for the concussion discussion was the Consensus Statement on Concussion in Sport[4], which was presented at the 4th International Conference on Concussion in Sport that was held in Zurich in November 2012. While that paper was an update of past papers presented in 2001 and 2008, different sporting codes in Australia appear to have used the Consensus Statement as a catalyst for implementing policies and concussion management advice. The Sports Concussion Assessment Tool[5] also developed by the authors of the Consensus Statement has been endorsed by most, if not, all top codes of sport in Australia with recommended use for all playing levels. 

Australia's 2017 football season is about to launch, and while many codes have not made substantial changes to policies, it is important that all involved in sports, whether it be coaches, players, parents or umpires, have an understanding of the basics of concussion management and what steps are to be taken before a return to play to their chosen sport. 

To assist, this article offers an overview of concussion management in each major sporting code in Australia. It is important to recognise that the term "concussion" is largely an historical term which, as the Consensus Statement outlines, represents "low-velocity injuries that cause brain “shaking” resulting in clinical symptoms and that are not necessarily related to a pathological injury". In the United States, the term mild traumatic brain injury (mTBI) is used interchangeably with concussion. Elsewhere, concussion is a subset of TBI.[6] Australia is well supported in concussion management by Governments and medical based organisations, with a summary of useful resources referred to at the conclusion.

Why concussion management matters - duty of care issue