BHA enhances concussion protocols
BHA enhances concussion management protocols
The British Horseracing Authority (BHA) has today announced a series of enhancements to its concussion management protocols, in order to ensure that riders are better protected and prevented from riding while under the influence of a concussive injury.
The enhancements, which come into effect from 1 August 2016, are being implemented across the full concussion management process, from baseline cognitive testing, trackside diagnosis and care through to post-injury follow-up, assessment and treatment and return-to-riding clearance. Their implementation follows a review of the existing concussion management protocols led by the BHA’s Chief Medical Adviser Dr Jerry Hill, in consultation with relevant stakeholders, including most crucially the Professional Jockeys Association (PJA)
The headline elements of the enhancements include:
· Extension of trackside screening test to ensure all riders who are involved in a fall are assessed for testing with symptom scores, balance and short and long-term memory (previously only memory was tested)
· Doctors will be given authority to test riders who were involved in a heavy fall a second time, approximately 25-30mins after the initial test, even if the rider passed the initial screening test, in case of late-onset concussion
· Involvement of other members of the racecourse team in encouraging potentially concussed jockeys to attend for (re)-testing with the medical team both doctors and nurses.
· Further research and development of an active rehabilitation programme for riders who have suffered concussion, on top of the existing enforced period of rest
· Ensuring riders are asymptomatic before submitting themselves for return-to-riding tests.
· Enhancement of “Cogsport” baseline testing to ensure all baseline tests are reviewed and evaluated to ascertain any tests which may need repeating for technical or clinical reasons
· Inclusion of IJF almoners in baseline testing process in order to make testing more convenient for riders
In addition to these enhancements, further improvements to the process are planned for the near future. These include a rewrite of the “Head Injury Instructions” guidance given to jockeys who are diagnosed with concussion, enhancements to the “helmet bounty” system whereby jockeys are given a stipend in exchange for returning the helmet they wore when suffering a concussion, and an extension of the administrative support around the concussion process in order to accommodate all of these enhancements.
In the longer term the BHA is working on a programme of education which will be designed to inform not only jockeys but any relevant individuals who work within the sport about how to diagnose concussion and the risks of continuing to ride when suffering from concussion.
Dr Jerry Hill, Chief Medical Adviser for the BHA, said:
“For some time British Racing has been recognised as pioneers when it comes to concussion management, as you would expect from a sport which carries an above average risk of concussion injury.
“However, it is essential that a sport should not be complacent about the management of such a serious issue as concussion. It is my intention that in British Racing we provide our jockey athletes with the appropriate guidance, treatment and care. This is why I am personally putting a renewed focus on the support these athletes receive in injury management as well as wellbeing, nutrition and mental health.
“The enhancements to our concussion management protocols will help reduce the risk of jockeys continuing to ride while suffering from a concussion. It will also aid their safe return to riding following a concussion injury.”
Notes to Editors:
1. The basics of concussion management in British Racing are as follows. Additions to the process are marked in bold. Please note, this is not an exhaustive summary of the process but simply covers the basic and immediate elements of trackside treatment and return-to-riding:
· Following a fall all Jockeys have to be assessed on the racecourse and if there is any suspicion of concussion undergo a sport-specific screening test of symptom score, short and long term memory and balance. If the diagnosis is not clear at that point a longer assessment can be undertaken with further questions and tests of neurological function including balance, memory and mental processing.
· Those with a positive test for concussion will be stood down from riding and either be sent to hospital, particularly if any other injuries are present, or allowed home accompanied by a responsible adult with specific follow up instructions in writing. They are advised not to drive.
· If symptoms are then recognised later, after the initial assessment, jockeys will undergo further assessment.
· In certain cases those riders who are involved in a heavy fall but pass an initial test can undergo a further assessment approximately 25 to 30 minutes after the first test – even if they are not displaying obvious symptoms – in case of late onset concussion.
· All jockeys are required to undergo baseline neuro-psychological screening at one of six regional centres prior to the granting of a licence. Following a concussive incident, a rider is immediately stood down for a minimum of six days. Following this stand down period a specialist reassesses the rider and a comparison is made of his/her repeat neuro-psychological tests against the baseline values. Only when these have returned to normal is the jockey allowed to return to race riding.
· During this process jockeys will be invited to take part in an active rehabilitation programme to aid their return to riding