If in doubt, sit them out: Why concussion should be part of your sport’s safeguarding framework

Safeguarding policies and procedures are informed by legislation and numerous guidelines to keep children and young people safe. Should the latest Concussion Guidelines form part of your safeguarding framework?

The Rugby World Cup kicked off with the France v New Zealand game last Friday, which also saw the new tackle height law changes in action. As of 1 July 2023, the legal tackle height in community rugby was lowered to from the base of the sternum. Commenting on this change, England Rugby said: “The risk of a concussion is 4.2 times higher when the tackler’s head is above the ball carrier’s sternum in the tackle” and that “research shows that by lowering the tackle height there will be a significant reduction in concussions.”

Why is concussion such a serious risk in sport?

As a contact sport, rugby remains one of the most high-risk sports for concussion and head injury. According to the England Professional Rugby Injury Surveillance Project 2020-21 Report, concussion was the most common injury in premiership rugby matches, accounting for 28% of all injuries. Such is the prevalence of head injuries in rugby, that more than 200 former rugby union players have brought a legal claim against three governing bodies alleging that they suffered brain injuries during their careers, leaving many with permanent neurological injuries.

Rugby is not the only sport in which concussions and head injuries remain significant problems, however. A report into concussion in sport by the Digital, Culture, Media and Sport Committee further highlighted the issue of concussion and its long-term impacts. According to the report, which was published in July 2021, the risk to former footballers of developing Alzheimer’s was five times greater than that of their contemporaries.

For sports at a grassroots level, which is “relatively unstructured” and “often organised by insufficiently trained volunteers with no dedicated medical oversight”, the risks can be even greater. The report highlights several issues specific to grassroots sport that place players at a higher risk than their elite and professional counterparts.

“The reality is that, for most people playing sport, there is no one to stop them [from playing after a suspected concussion] except themselves, their friends, teammates, and family,” the report said. “That is how far down the knowledge and awareness of concussion and how to respond to it must reach to ensure people seek the necessary help and treatment rather than returning to the field to the detriment of their long-term health.”

What are the Concussion Guidelines?

Published in April 2023, the UK Concussion Guidelines for Non-Elite (Grassroots) Sport provide the first single point of reference for recognising and managing concussion from the time of injury to a safe return.

“Research has shown the importance of fast and effective tailored treatment and we are issuing expert guidance to help people spot and treat head injuries,” said Sports Minister Stuart Andrew. “Whether used in a local leisure centre during a swimming lesson or on a village green during a cricket match, the guidance will make a real difference to people’s lives.”

The key message of the Guidelines is ‘If in doubt, sit them out’, which emphasises the importance of immediately removing anyone with a suspected concussion from play.

To support all participants in achieving this, the Guidelines contain medical information regarding visible signs and symptoms of concussion, as well as the red flags that could require urgent medical assessment.

Once a concussion is suspected and the affected person has been removed from play, the Guidelines cover the actions required within the first 24 to 48 hours to keep a player safe and aid recovery. They also offer support on conducting a graduated return, first to education and work, and then sport.

What role do the Guidelines play in safeguarding children and young people?

Although these Guidelines are just that – guidelines – they will play a key role in a sporting organisation’s safeguarding obligations and should not be ignored. As the report states, a concussion is a brain injury and “all concussions are serious”, which means it is everyone’s responsibility to ensure that they can recognise the warning signs and support the affected player in treating, managing, and recovering from a concussion.

Nor should these Guidelines be viewed in isolation. A sporting organisation should consider them as part of its overall safeguarding obligations, as well as its health and safety procedures, to make sure they are adapted to the specific needs of the sport and its players.

For example, if a sport requires frequent physical contact, like rugby, or uses heavy or hard equipment, like cricket, an organisation may wish to extend the graduated return recommended by the Guidelines or stipulate that certain positions within the sport be out of bounds for individuals until a medical professional can advise that they have fully recovered.

The consequences of not engaging with these Guidelines could be severe. In a worst-case scenario, where a player has suffered from a severe concussion or head injury and is experiencing long-term health issues as a result, investigating third parties will want to see evidence of an organisation’s safeguarding procedures concerning concussion. They will also expect to see any initiatives the organisation has taken to disseminate such procedures among all stakeholders.

Organisations failing to demonstrate this could not only face irreparable harm to their reputation and that of the sport, but also potential criminal and civil proceedings.

What should a sporting organisation do next?

The immediate priority is, of course, to read the Guidelines. An organisation’s governing body should examine how these Guidelines apply to the sport and evaluate where and how they can be incorporated into existing safeguarding policies. In some cases, it may be deemed necessary to create a separate policy on concussion to supplement existing policies.

Any updates to safeguarding policies and procedures must then be communicated as widely as possible. Organisations should use as many channels as possible, including emails, posters, and announcements on social media, to make sure all stakeholders are aware of their obligations. At this point, it is also helpful to check that stakeholders are aware of the lines of communication, should an incident occur. Does the organisation have user-friendly flowcharts on reporting lines, for example, and does everyone know where to find them?

It is also essential that training be provided – both on a mandatory and a voluntary basis, depending on the target audience. For any appointed trained officers or first aiders, for example, knowing how to respond to possible signs of concussion is essential and training, therefore, should be mandatory. More flexible, informal training on the Guidelines – as well as an overall refresher of the organisation’s safeguarding policies as a whole – can also be provided to parents and volunteers. The more individuals who are aware of the Guidelines, the easier it will be to keep children and young people safe.

As Peter McCabe, chief executive of charity Headway, states: “It will never be possible to ensure that sport is one hundred per cent safe. It should, however, be expected that participants are aware of the risks involved and there is a precautionary approach to risk management. The Government cannot avoid taking a proactive role in ensuring that this occurs.”

For most who participate in sport, the benefits to mental and physical wellbeing far outweigh the risks. Nevertheless, it is important that concussion is acknowledged as a potential risk. This is so that future generations across elite, professional, and grassroots sport can practice the sport that they love, without facing the neurological issues that so many sports stars are facing now. Such stars include rugby World Cup winner Steve Thompson, whose early onset dementia robbed him of the memory of receiving an MBE from the late Queen Elizabeth II.

These Guidelines are not a legal requirement, but safeguarding obligations are. To ignore the Guidelines is to go against their purpose to protect the welfare of children and young people and ensure that everyone who participates in sport can reap the benefits for many years to come.