Head Trauma Protocol

Purpose:

To provide a clear, evidence-based protocol for managing head injuries, including concussions, sustained during judo activities (training, sparring, or competitions) to protect players’ short- and long-term health and ensure safe return to play.

Scope:

This plan applies to all Judo Aotearoa members, including players (children, adolescents, and adults), coaches, officials, and parents/guardians, across all affiliated clubs and events.

1. Definitions

• Head Injury: Any trauma to the head, face, neck, or body causing rapid movement of the head, potentially leading to brain injury (e.g., concussion, subdural hematoma).

• Concussion: A mild traumatic brain injury (TBI) caused by a bump, blow, or jolt to the head or body, resulting in temporary brain function impairment. Symptoms may include headache, dizziness, confusion, nausea, or loss of consciousness.

• Acute Subdural Hematoma (ASDH): A serious condition involving bleeding between the brain and skull, often associated with judo throws (e.g., Osoto-gari, Ouchi-gari), requiring immediate medical attention.

• Ukemi: Judo breakfall technique to minimize injury during throws, critical for reducing head trauma risk.

2. Immediate Response to a Head Injury

When a player sustains a head injury or is suspected of having one (e.g., after a throw, collision, or fall):

• Stop Activity:

  • Immediately halt the activity (training, randori, or competition).

  • The player must not continue participating until medically cleared.

• Ensure Safety:

  • Ensure the scene is safe before approaching the player.

  • Do not move the player unless absolutely necessary (e.g., to avoid further harm).

  • Check for consciousness, airway, and breathing. If unconscious but breathing, place in the recovery position and call 111.

• Initial Assessment by Coach or First Responder:

  • Coaches or designated first-aiders (trained in basic first aid and CPR) should perform a preliminary assessment:

    • Signs to Observe: Loss of consciousness, confusion, headache, dizziness, nausea, vomiting, balance issues, blurred vision, or unequal pupils.

    • Ask Questions: “Do you know where you are?” “Do you feel dizzy or nauseous?” “Do you have a headache?”

  • If any signs of concussion or serious injury are present, assume a concussion until proven otherwise.

  • Apply a cold cloth or ice wrapped in cloth to the injury site (avoid direct pressure if a skull fracture is suspected).

• Emergency Action:

  • Call 111 if the player exhibits:

    • Loss of consciousness (even briefly).

    • Seizures, vomiting, or worsening symptoms.

    • Severe headache, neck pain, or suspected spinal injury.

    • Signs of ASDH (e.g., persistent headache, neurological deficits).

  • Stay with the player until emergency services arrive.

• Remove from Play:

  • Any player with a suspected head injury must be removed from activity immediately and not return on the same day, even if symptoms appear to resolve.

• Notify and Document:

  • Inform the player’s parent/guardian (for minors) or emergency contact.

  • Complete a Concussion Reporting Form to document the incident, including mechanism of injury, symptoms, and actions taken. Submit to Judo Aotearoa within 24 hours.

3. Medical Evaluation

• Mandatory Medical Assessment:

  • All players with a suspected head injury must be evaluated by a healthcare professional (e.g., GP, emergency department, or concussion specialist) as soon as possible, ideally within 24 hours.

  • For children and adolescents, use a conservative approach due to the developing brain’s vulnerability.

• Imaging:

  • Imaging (e.g., CT scan) is not routine for uncomplicated concussion but is indicated for suspected skull fracture, intracranial bleeding, or neurological deficits. 

• Diagnosis:

  • A healthcare professional will diagnose concussion or other head injuries based on history, symptoms, and clinical examination. Neurological findings are often normal in concussion, but balance and mental status may be impaired.

4. Treatment Protocols

• Initial Management (First 24–48 Hours):

  • Rest: Minimize physical and cognitive activity (e.g., avoid screens, reading, or strenuous exercise) to allow brain recovery.

  • Hydration and Nutrition: Ensure adequate hydration and balanced nutrition. Avoid alcohol or medications unless prescribed.

  • Pain Management: Paracetamol may be used for headaches, but avoid aspirin or ibuprofen due to bleeding risks. Consult a doctor before administering any medication.

  • Monitoring: A responsible adult (parent/guardian for minors) must monitor the player for 24–48 hours for worsening symptoms (e.g., increased confusion, vomiting, or seizures).

• Ongoing Care:

  • Follow medical advice for symptom management. Most concussion symptoms resolve within 7–10 days in adults and 10–14 days in children.

  • Refer to a concussion clinic or neurologist if symptoms persist beyond 10 days or worsen (e.g., post-concussion syndrome).

  • For severe injuries (e.g., ASDH), neurosurgical intervention may be required. Ensure prompt referral to a tertiary care facility.

5. Stand-Down Period

• Minimum Stand-Down:

  • Players diagnosed with a concussion must not return to judo (training, sparring, or competition) for a minimum of 21 days for adults and 30 days for children/adolescents (under 18), starting from the date of injury. This aligns with conservative management due to judo’s high-risk nature.

  • Players with a history of prior concussions or severe symptoms may require longer stand-down periods, as determined by a doctor.

• No Same-Day Return:

  • No player with a suspected or confirmed concussion may return to play on the day of injury, regardless of symptom resolution.

• Serious Injuries:

  • For severe head injuries (e.g., ASDH, skull fracture), return to judo is prohibited until cleared by a neurosurgeon, often requiring months of recovery.

6. Graduated Return-to-Play (GRP) Protocol

Players may return to judo only after being symptom-free and receiving medical clearance from a healthcare professional. The GRP protocol, adapted from the Concussion in Sport Group (CISG), progresses through stages, with each stage requiring at least 24 hours symptom-free before advancing.