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When do you take an athlete with a possible concussion to a hospital?

A lot depends on the level of concussion management expertise present at the sideline. If there is no one available with a working knowledge of concussion assessment at hand, a conservative approach is the best. 

I recommend that before the season starts, each team should appoint a concussion coordinator. Athletic trainers are ideal for this position. In the absence of athletic trainers, team doctors, assistant coaches, volunteer parents or local EMTs are good candidates. During the pre-season preparations, the concussion coordinator is responsible for appropriate concussion prevention items like ensuring proper-fitting protective equipment and that goal posts are properly padded; that athletes, coaches, and parents are properly educated with concussion awareness materials; and that all athletes participate in baseline cognitive testing. The concussion coordinator should become familiar with signs and symptoms of concussion and the use of sideline concussion assessment tools. This person should be available at every game and practice, and have the authority to pull an athlete to the sideline for an assessment if an injury is suspected. 

Red flag signs that emergency room referral is appropriate include:

Loss of consciousness more than a minute, lethargy/confusion greater than 30 minutes, weakness/numbness (or other focal neurologic impairment), neck pain, persistent double vision, severe headache, worsening condition during the sideline assessment, or something "is just not right" about the athlete. 

Remember that an unconscious athlete should always be assumed to have sustained a neck injury and should not be moved until evaluated by the appropriate medical personel. 

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.