AN OVERVIEW OF OUR SPORT’S CONCUSSION PROGRAM AND PROTOCOL
Implemented as a volunteer program in 2012 and subsequently a mandatory program in 2013 for all AMA licensed Supercross and Motocross athletes, the Medic Rig’s concussion program became the first motorsports comprehensive program for the evaluation and treatment of sports related concussion(SRC). It has also become the template for other motorsports programs.
In contrast to most team sports, the motorsports athlete will compete on the weekend, but return home during the week for conditioning, practice, and medical care if needed. This presents a challenge to coordinate consistent evaluation and care following a SRC occurring during competition outside of the athlete’s home area. The Supercross/Motocross athletic population also includes both adult and pediatric athletes, which have different risk factors. The standard of care for the evaluation and treatment of SRC has evolved and continues to evolve as reporting of injuries and research knowledge has increased rapidly. Our concussion team is committed to providing the highest level of concussion care.
Motorsports related concussion does not appear to be as frequent when compared to American football, but the magnitude of the traumatic brain injury can be more significant. This is due to the speed and the height of the falls involved in the injury. Once an athlete is suspected of sustaining a concussion at the race, they are immediately required to present for evaluation at the Alpinestars Mobile Medical Unit. The athlete is not allowed to return to practice and/or racing. Through a combination of history including the mechanism of injury, physical examination including neurologic examination and balance testing, the Sports Concussion Assessment Tool (SCAT5), with repetitive evaluation, it is determined if the diagnosis of concussion is confirmed. If more serious head trauma is suspected, the athlete will be transported to the local trauma center. If a concussion is confirmed, the athlete is disqualified from further participation for that day and placed into the concussion protocol. If information is obtained that an out-of-competition practice crash has occurred, the athlete will also be required to present for evaluation and possible inclusion into the Concussion Protocol.
The athlete and his caretaker will be provided with a concussion injury education and advice sheet. They will also be provided with a detailed handout of the Return to Ride Protocol. They are instructed in brain and physical rest until symptom free for 24 hours. Athlete contact information will be obtained, recorded in the chart, and forwarded to the Concussion Coordinator and/or Medical Director. The athlete will generally return home and be contacted by the Coordinator on Monday morning.
Prior to beginning the return to ride program, the athlete must be evaluated by a physician or neuropsychologist experienced in the evaluation and treatment of sports related concussion. The Coordinator will assist the athlete in obtaining care in their local area. The treating physician will also arrange for administration of a proctored ImPACT neurocognitive examination (not online). Only after the physician examination is normal, all symptoms have resolved, and the ImPACT test has returned to baseline can the athlete begin the supervised Return to Ride Protocol. The protocol has five phases with the first being the brain and physical rest. The protocol requires no symptoms throughout the exercises to advance to the next phase. Once the protocol is completed, the physician and observer sign off.
The athlete then presents to the Alpinestars Mobile Medical Unit on the first day they plan to return to racing. The athlete presents his completed evaluation and physician sign off forms. The AMMU physician will then perform another evaluation for final clearance to race that day. The AMMU staff will then closely observe the athlete during practice and races to help insure the athlete’s safe return.
Although 85% of all sports related concussions resolve in 7-10 days, it is impossible to determine on the day of injury how quickly the athlete will return to a normal state. Some recoveries can be quite prolonged despite mild initial signs and symptoms. It has been shown that in other contact athletes, recurrent concussions are increased and permanent long term sequelae may occur if the initial injury is not allowed enough healing time. Greater magnitude injuries including bleeding within the brain will require neurosurgical and/or neurology release prior to returning.