HEADSTRONG: PREVENTING AND MANAGING TRAUMATIC HEAD INJURIES
Concussion and other head injuries can have devastating consequences, and children, the elderly, and contact sport participants are at greater risk. ER24 and SA Rugby have partnered to educate the rugby community and safeguard players at all levels from head injuries.
Worldwide, at least 30 million head injuries are estimated to to occur each year. Young children under the age of four and the elderly over the age of 75 are most commonly affected by head injuries, says Dr Alexander Landmann, a neurologist at Mediclinic Sandton. “Contact sports obviously have a high incidence of acute and chronic traumatic brain injuries (TBIs),” he adds.
Figures from SA Rugby published in January 2023, show that in the years from 2001-2022, combined numbers of traumatic head and spinal injuries in adult and schoolboy rugby in South Africa totalled 257, including 33 fatalities.
While any brain injury can have lingering effects, the severity of a brain injury determines its impact, says Dr Landmann, “Even mild traumatic brain injuries – concussions – can have long-lasting effects on memory, concentration, mood and sleep patterns. The more severe the mechanism of injury, the more likely there can be irreversible brain injury, which leads to permanent alteration in function.
“Recurrent concussions can lead to chronic traumatic encephalopathy – a brain disorder that results in irreversible impairment of brain function.”
Prevention and treatment of brain injuries
In severe cases, brain injuries can result in irreversible damage, or even death. “There is no medication or intervention that can reverse the effects of a brain injury or fix an injured brain,” Dr Landmann explains. “Recovery will happen spontaneously given the right conditions, but often there is a permanent neurological fallout.
“Since the most frequently affected group are very young children, parents need to take responsibility by supervising their children correctly and making sure they’re always placed in a safety seat when travelling by car. In older people, education about prevention of falls is important, and it’s crucial that they retain good physical fitness. Children and adults involved in contact sports should wear protective gear whenever possible.”
No magic pill exists for brain and spinal injury treatment, but doctors can work to improve outcomes. “The management of mild TBI – concussion – involves rest, avoiding excessive stimulation and appropriate treatment of complications such as headache,” Dr Landmann says. “Severe TBI usually requires hospitalisation, management of brain swelling, prevention of complications such as seizures, and possibly neurosurgical interventions.”
No medication or intervention can reverse the effects of a severe traumatic brain injury (TBI). Recovery will happen spontaneously given the right conditions, but often there is a permanent neurological fallout.
The BokSmart programme
To prevent head injuries on the rugby field or provide vital, immediate treatment, ER24 has teamed up with SA Rugby to create BokSmart, a national rugby safety programme that educates coaches and referees about injury prevention and management, rugby safety, and player performance.
As part of this initiative, the SA Rugby BokSmart Spineline programme, ER24 manages a dedicated emergency helpline for rugby-related head and spinal injuries. The programme is designed to provide the best, most appropriate and fastest pre-hospital emergency medical care to treat potential serious concussion, head, neck and spine injuries sustained while playing rugby.
ER24 paramedics are also often stationed at rugby matches, whether at high schools, colleges, or professional fixtures. “Concussion, head injury and spinal injuries are a major focus for us, as they can be serious and may be difficult to identify immediately,” says Dr Robyn Holgate, Chief Medical Officer ER24 and Emergency Medicine Manager MCSA.
“Our paramedics are trained to spot certain signals: a player might be confused or unsteady on their feet. They might be irritable, or dazed, or even suffering convulsions. How we respond in that moment can have a lasting effect on that player’s wellbeing, so we have to be trained and ready to treat them properly.”
“Problems such as swelling of the brain or seizures must be recognised and treated immediately, otherwise the outcome will be poor,” Dr Landmann explains. “That is why such initiatives are so important.”
Contact the BokSmart Spineline on 0800 678 678.
