Guard against head injuries in sport

July 3, 2015

With focus on head injury awareness, ER24 is urging people to be aware that these injuries are often sustained while participating in sport, especially contact sports. Know what to do if someone sustains a head injury.

While head injuries are common in sport, these injuries and the prevention thereof are taken seriously. Looking at rugby in South Africa for example, a number of programmes have been established to reduce injuries.

In 2006, the South African Rugby Union (SARU) in conjunction with the Chris Burger Petro Jackson Players’ Fund embarked on developing a plan to reduce the increasing number of serious head, neck and spine injuries associated with the game. The BokSmart National Rugby Safety programme was officially launched in 2009. Its guiding principle is to use an evidencedriven and evidence-based approach to set the rugby safety standard duty of care required for rugby played in South Africa. BokSmart promotes safety in schools and clubs in a number of ways including free mandatory coach and referee education on related techniques and strategies around injury prevention and management.

Jeppe High School for Boys is one of several rugby-playing schools that takes the prevention of injuries in the sport seriously.
Jeppe Boys (which was attended by Springboks Wilf Rosenberg, Des Sinclair, James Dalton and Brent Moyle as well as Jake White, World Cup winning coach who was also a teacher at the school) has been involved in rugby since 1935.

When asked what Jeppe does to reduce or address head injuries, Jason Tee, the head of the department for physical education, said, “The largest determining factor in the likelihood of head injuries in rugby is poor tackle technique. Our coaches are Boksmart qualified and we perform regular contact skills training sessions where appropriate tackle technique is taught. We offer all boys the opportunity to register for the Sports Concussion South Africa programme. “Through this programme, boys perform a computerised baseline brain function test.

“In consultation with a registered sports physician, this test is then used to determine when a boy can safely return to play following concussion.” If a player sustains a blow to the head, a protocol called the recognise and remove procedure for concussion is followed. “All coaches have been trained through the BokSmart programme to recognise the signs and symptoms of concussion. If there is any doubt, players are removed from play. Paramedics are on duty during all matches and assist with recognising players who may have suffered head injuries,” said Tee.

An ambulance is on call and paramedics are present at every match. Any player suspected of having a concussion is immediately referred to emergency personnel on duty. “Coaches, referees and players do have a good understanding of injuries and how they should be managed. It is a requirement that all coaches and referees are accredited by BokSmart to be able to safely manage matches and practice. We host additional ad hoc training sessions to further up skill our coaches in the management of injuries. We have a number of staff with first aid qualifications who can initiate emergency care,” said Tee. BokSmart also develops regulations, minimum standards and policies to protect rugby players within the context of the game.

Dr Wayne Viljoen, BokSmart manager at SARU, said there has been a decrease in serious head, neck and spine injuries at clubs and schools since the establishment of BokSmart. Some aspects that contributed to the decrease include coaching, refereeing, player preparation, education and awareness.

Coaches, referees and medical staff on duty at matches and practices have contributed to the decrease by implementing correct injury prevention and management strategies. “Without these important role players, a programme such as BokSmart cannot be effective,” said Dr Viljoen.

BokSmart Spineline
BokSmart Spineline is a dedicated emergency helpline for potentially serious concussion, head, neck and spine injuries sustained during a rugby match or practice.
This toll free number is linked to ER24. ER24 provides telephonic advice, initial telephonic screening and dispatches or arranges suitable transportation of the injured player to the nearest and most appropriate medical facility. If a player is unconscious or unresponsive, or has an obvious head, neck or spine rugby injury, contact BokSmart Spineline on 0800 678 678 to log the incident or access emergency advice.

Signs and symptoms
Dr Viljoen said all head injuries should be approached and handled with a potential neck injury in mind until proven otherwise.
“Do not roll an unconscious player over without first stabilising the neck. If a player complains about substantial neck pain, he should be managed strictly according to cervical spine injury protocols and be stabilised and removed from the field on a spinal board.

“Once a significant neck injury has been excluded, the whole principle around concussion is recognise and remove,” he said.

What you need to look for:
– A player who has a dazed, vacant or blank expression.
– A player who is lying motionless on the ground, gets up very slowly, is unsteady on the feet, has balance problems or falls over, suffers loss of consciousness or has a lack of responsiveness.
– Confusion, grabbing or clutching of the head, convulsions.
– A player who is more emotional or irritable.

The player might tell you they have a headache, are experiencing dizziness, struggling with or blurred vision, experiencing nausea or vomiting, fatigue, drowsiness, a feeling of pressure in the head and sensitivity to light or noise. All players who are suspected of having a concussion during a rugby match or training must be removed from the field of play and may not return to play or train on the same day. They must be medically assessed afterwards by a medical doctor who understands concussion and be diagnosed as either having a concussion or not. Because signs and symptoms can be missed, must then in any case, as a precaution, complete the graduated return to play protocol described in the World Rugby Concussion Guidelines, regardless of having been positively diagnosed or not by the medical doctor.

ER24’s Emergency Contact Centre can be reached 24 hours a day on 084124.
ER24’s Specialised Medical Services division can be booked for events by emailing

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