Concussion Education in the ED - What's In it for Nurses and Families?

As we head into the fall sports season, the ED will be handling more and more sports injuries. How do we educate ourselves as well as families of patients who sustain these injuries?

Concussion Education in the ED - What's In it for Nurses and Families?

Football season is upon us! We all like to dress warmly and go out on Friday or Saturday evening to cheer on our local high school team or bundle up to go to the ice rink to watch our teams. Some of the highest concussion rates among athletes under the age of 18 are ice hockey and football. According to the Brain Injury Research Institute:

"The condition known as mild traumatic brain injury is more commonly referred to by the term concussion. While a severe concussion will normally be referred to as a traumatic brain injury or TBI, normal concussions are referred to as being mild traumatic brain injuries (MTBI) due to the fact that a single injury of this type will not typically cause any serious long term health consequences. Several repeated mild traumatic brain injuries, however, may lead to the life-changing and potentially debilitating condition known as chronic traumatic encephalopathy (CTE)."

The Emergency Nurses Association emphasize the important role that emergency department (ED) nurses play in the education of these patients and their families/caretakers.

One of their upcoming presentations will feature Georgia ENA State Council President Jack Rodgers, MBA, BSN, RN, CEN, NREMT-P. He states, "Parents, teachers, coaches and medical professionals all have the same priority to preserve the safety and well-being of our students.” Rodgers is a clinical educator, paramedic and emergency department nurse based in Columbus, Georgia. “In the emergency department, nurses are regularly the first person to see a patient for triage and the last to see them before being discharged. It is imperative that nurses can identify obscure symptoms and recognize severe cases to expedite treatment when necessary, to prevent long-term effects. But it’s equally important for our emergency nurses to discuss the seriousness of recovery protocols with students and parents upon discharge; emphasizing the Return to Learn protocol to decrease Second Impact Injury possibilities and promote a healthy and safe return to regular activities.”

How Prevalent are Concussions?

In 2017, the Centers for Disease Control and Prevention estimated that 2.5 million high school students sustained at least one concussion related to sports or physical activity. An estimated one million students reported having two or more concussions, with students that play on a sports team placed at higher risk. Even more threatening is Second Impact Syndrome, a second head injury before complete recovery from an initial head injury, which can be fatal.

What About Recovery?

Just as important as diagnosing a concussion, prescribing the right path to recovery is of growing prominence. The protocols of concussion recovery have dramatically changed over the decades. This isn’t the age of “rub some dirt on it” and get back on the field or in the classroom.

The Centers for Disease Control (CDC) have an expected timeline for symptom resolution:

1. Rest - Your child should take it easy the first few days after the injury when symptoms are more severe. Early on, limit physical and thinking/remembering activities to avoid symptoms getting worse. Avoid activities that put your child at risk for another injury to the head and brain. Get a good night’s sleep and take naps during the day as needed.

2. Light Activity - As your child starts to feel better, gradually return to regular (non-strenuous) activities. Find relaxing activities at home. Avoid activities that put your child at risk for another injury to the head and brain. Return to school gradually. If symptoms do not worsen during an activity, then this activity is OK for your child. If symptoms worsen, cut back on that activity until it is tolerated. Get maximum nighttime sleep. (Avoid screen time and loud music before bed, sleep in a dark room, and keep to a fixed bedtime and wake up schedule.) Reduce daytime naps or return to a regular daytime nap schedule (as appropriate for their age).

3. Moderate Activity - When symptoms are mild and nearly gone, your child can return to most regular activities. Help your child take breaks only if concussion symptoms worsen. Return to a regular school schedule.

4. Back to Regular Activity - Recovery from a concussion is when your child is able to do all of their regular activities without experiencing any symptoms.

ENA Adds Some Tips

The first phase of the Return to Learn plan calls for total cognitive and physical rest that should last three days once the student is symptom-free for 24 hours. According to the Brain Injury Association of America, “it requires staying away from thinking, learning, memorizing, and even things like reading, texting, computer time, and watching TV for the first day or two following an injury” and includes physical rest. The second phase calls for light thinking activities, listening to calm and relaxing music or playing familiar games for a day or two followed by a return to school part-time or half days.

“Provided conditions don’t worsen, a gradual return to activities, both on the field and off, has proved to be the best approach,” said Rodgers. “Parents can help by making sure their child gets both cognitive and physical rest, followed by a gradual return to activity. Obviously, parents should be in communication with their health care provider throughout the process.”

ENA has annually offered training on traumatic head injury prevention and treatment while proactively educating members on the latest research and head trauma recovery methods. Emergency Nursing 2019 is another avenue for keeping members up to date on the latest clinical trends and techniques.

“With more and more concussion-related research becoming available, our goal is to empower emergency nurses with the tools they require to provide the highest level of care for head injury patients,” said ENA President Patti Kunz Howard, PhD, RN, CEN, CPEN, TCRN, NE-BC, FAEN, FAAN. “This information allows nurses to step outside the emergency department to engage their communities, enabling them to serve as medical volunteers at community sporting events, discuss preventative and diagnostic measures with their local schools or to share their education with coaches, parents and students to help patients during their road to recovery.”

The Emergency Nurses Association offers many opportunities to further your skills, education, and career.

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traumaRUs

About traumaRUs, MSN, APRN

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Specializes in kids.

Great article! As a HS nurse, I would encourge the hospital/ER/Urgent Care to consider the schools role in returning to learning and athletics. An MD writing "clear to return" says to the athlete and parent,

"they are all set, lace'em up and get out there and play".

There may (and should) be protocols in place so that the athletes start with a small amount of movement and increasing the heart rate on a gradual basis, getting back to baseline activity, usually over a period of 4-5 days.

I cannot begin to tell you how difficut it is to argue with parent and kids who just want to play because the MD said they were good.

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Specializes in School Nursing.

Most MD notes end up being "restrict gym/recess" and then clear to "return to activities". These fail to acknowledge classroom changes that may be needed. The CDC has a great check sheet that I wish more providers would use to give teachers guidelines for a student's individual needs.

https://www.cdc.gov/traumaticbraininjury/pdf/pediatricmtbiguidelineeducationaltools/mTBI_ReturntoSchool_FactSheet-Pin.pdf

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Specializes in Nephrology, Cardiology, ER, ICU.

Great comments - thanks for the additional link.

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If you're not familiar, the PECARN Head Injury/Trauma Algorithm is great for reassuring parents, and when advocating for/against imaging in the pediatric population:

https://www.mdcalc.com/pecarn-pediatric-head-injury-trauma-algorithm

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