Concussion: recognizing the signs and taking the right steps

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The fall sports season is starting again. Soccer, football, hockey, mountain biking: training is resuming everywhere in Quebec, and with it, head impacts. First aid for concussions requires neither sophisticated equipment nor a medical degree. It primarily requires recognizing the signs, immediately removing the person from play, and not leaving them alone. A concussion is an invisible injury: nothing bleeds, nothing is broken, and that's precisely what makes it tricky. Here's how to react calmly and competently, whether you are a parent, coach, colleague, or simply a witness.

What exactly is a concussion?

A concussion is a mild traumatic brain injury (mTBI). A sudden back-and-forth movement of the head causes the brain to move inside the skull, temporarily disrupting its function.

Two misconceptions to set aside:

• Loss of consciousness is not necessary. The vast majority of concussions occur without any loss of consciousness.
• The impact doesn't necessarily have to be to the head. A violent blow to the body—a check, a fall on the back—can be enough to shake the brain.

According to the Quebec government, symptoms can appear up to 48 hours after the incident. Therefore, you can never conclude "he's fine" within five minutes of an impact.

Signs to watch for

Some signs are visible to others, while others can only be reported by the person themselves. Ask simple questions and listen to what they say.

• Physical signs: headaches, dizziness, blurred vision, nausea, sensitivity to light or noise, unusual fatigue, loss of balance.
• Cognitive signs: feeling "slow" or "in a fog," difficulty concentrating, memory gaps, confusion about the score or time of day.
• Emotional signs: irritability, sadness, anxiety, more intense reactions than usual.

Just one of these signs after an impact is enough to suspect a concussion. When in doubt, treat it as if it were a concussion.

Immediate first aid: the removal rule

The most important action requires no equipment. It can be summed up in one sentence: remove the person from play, and they do not return to play the same day. Even if no symptoms appear, avoid any activity with a risk of contact, collision, or fall for 24 to 48 hours.

1. Stop the activity immediately. No "I'll finish the period." No "it'll pass."
2. Seat the person in a quiet place, in the shade, away from noise and screens.
3. Never leave them alone during the first few hours. A responsible adult stays with them and notes what they observe.
4. Do not give anything to drink or eat before medical evaluation.
5. Do not remove the helmet or any other equipment. After a blow to the head, always assume a possible neck injury: do not move the person, ask them to remain still, and wait for help.
6. Have the person evaluated by a doctor quickly, even if they seem to be feeling better.

Record the time of impact, how it happened, and the symptoms observed. These notes are invaluable for the doctor—and for the workplace accident report.

When to call 911 without hesitation

Certain warning signs indicate a more serious head injury than a concussion. They can appear immediately, within hours, or up to two days later. Call 911 if you observe:

• loss of consciousness, even brief;
• neck pain or tenderness;
• severe or worsening headache;
• repeated vomiting;
• double vision or vision loss;
• seizure or uncontrollable tremors;
• difficulty speaking or walking;
• increasing confusion, unusual agitation, abnormal drowsiness;
• weakness or numbness in an arm or leg;
• blood or clear fluid leaking from the nose or ears.

If the person loses consciousness and is breathing normally, place them in the recovery position while protecting their head and neck, then monitor their breathing until help arrives.

Return to play is not improvised

In Quebec, concussion management in sports and schools is governed by a government protocol that provides for a gradual return in successive stages, with the authorization of a health professional.

The principle is simple: you only move to the next stage if no symptoms reappear for at least 24 hours. First, active rest—calm activities rather than complete bed rest—then light walking, then non-contact exercise, then contact training, and only at the end, the game.

Why such caution? Because a second impact on a brain that has not yet healed can have much more severe consequences. This is where the coach and parent play their most useful role: saying no.

Be equipped and trained for the season

On the sidelines, a first aid kit doesn't replace judgment, but it allows you to manage everything that accompanies an impact: a cut on the forehead, a nosebleed, a bruise, an ankle sprain. A first aid kit kept in the team bag, checked at the beginning of the season, changes your ability to intervene. Also remember to restock what was used last year: our first aid supplies can be ordered by the piece.

And above all: recognizing a concussion can be learned. An online first aid training gives you basic reflexes in a few hours, at your own pace. To learn more, also consult our article on first aid for sports injuries.

Key takeaways

A concussion does not bleed and is not visible on an X-ray: it is recognized by its symptoms. Just one sign after an impact is enough to remove the person from play, keep them accompanied in a quiet place, and have them evaluated by a doctor. Symptoms can appear up to 48 hours later, so continued monitoring at home is essential. If there is a warning sign—loss of consciousness, repeated vomiting, worsening headache, double vision, seizure—call 911. Prepare for the season now: check your first aid kit and take an online training to intervene with confidence.

Sources: Institut national de santé publique du Québec — Government of Quebec Concussion Management Protocol · Canadian Red Cross — First Aid: How to Treat Concussions and Other Head Injuries

This article is for educational purposes only. In case of emergency, call 911.