Concussions

A concussion is a traumatic brain injury caused when the brain is shaken in the skull. A blow to the head, a blow to another part of the body that jolts the head, or any forceful movement of the brain can result in a concussion. Concussions can be challenging to detect because they are not typically visible on routine diagnostic imaging, such as X-rays, Magnetic Resonance Imaging (MRI), or Computed Tomography (CT) scans.  

Some workplace events that can lead to a concussion are:

• An object falls on top of a worker’s head
• An object strikes a worker’s head, face, or neck from any direction
• A worker forcefully collides with an object or person
• A person or moving object (such as mobile powered equipment) forcefully collides with a worker
• Workplace violence that results in a physical altercation
• A worker falls from a height
• A worker falls from the same level and hits their head on the floor or a solid object
• Whiplash or rapid movements of the head (such as a motor vehicle collision or a blow to the body that jars the head)

Any worker can suffer from a concussion. The risk to a particular worker depends on the hazards in the workplace and how likely those hazards are to cause harm. A risk assessment can help identify the hazards and recommend appropriate control measures.

Factors that could affect getting a concussion include:

• Engaging in activities that could result in blows to the head or shaking of the brain (such as working at heights)
• Working in an area where there are hazards that could strike the head or shake the brain (such as where loads are frequently being moved)
• Working in an area or profession where workplace violence is likely
• Having a previous concussion (having had an initial concussion increases the risk of sustaining another)

Some industries and occupations where there is a high risk of concussions include:

• Construction
• Healthcare
• Manufacturing
• Warehouse workers
• Professional athletes in high-impact sports (such as hockey, football, and combat sports)

A worker can experience symptoms of a concussion even if it does not appear in diagnostic imaging (such as a CT scan). It is also possible to have a concussion even while having no signs of an external injury, such as a cut, laceration, or swelling of the head (although these signs can, in some situations, indicate a concussion).  

Symptoms of a concussion can be mild, delayed, or absent. A healthcare professional can make a diagnosis by evaluating the signs, reviewing medical history, and conducting relevant tests (such as a neurological examination and cognitive testing). Not everyone will experience a concussion the same way, and symptoms may be delayed. 

The following are symptoms that someone with a concussion may experience:

• Headache
• Dizziness
• Nausea
• Memory issues
• Difficulty focusing or thinking clearly
• Behavioural changes
• Blurry vision
• Neck discomfort or pain
• Feeling of being “in a fog” 
• Sensitivity to light or sound
• Ringing in the ears 
• Slow to answer questions or follow directions
• Problems with balance or coordination
• Excessive sleep or problems falling asleep 
• Unusually emotional (such as being overly anxious or quick to anger) 

When a worker experiences more serious symptoms, emergency medical attention is needed right away. More serious symptoms can include:

• Double vision
• Severe headache
• Neck pain
• Repeated vomiting
• Seizures
• Loss of consciousness
• Increasing confusion
• Weakness or tingling in their arms or legs
• Slurred speech

It is better to prevent concussions than to treat them. A risk assessment should be conducted to identify hazards that could result in concussions and recommend suitable control measures. 

A concussion protocol can be developed based on the identified hazards. It can include policies and procedures that acknowledge hazards, establish response measures, and promote worker training and education on concussions.

Consider the following preventive tips:

• Separate workers from activities that could cause a concussion. For example, establish a no-worker zone when there are operations for moving loads with cranes, and use physical barriers to separate walkways from motorized traffic
• Implement measures to control hazards that could lead to a head injury. For example, use tool tethers, toeboards, and safety nets to prevent overhead objects from falling onto workers below 
• Improve workplace design to help clearly identify workplace hazards. For example, install guardrails in elevated areas and improve lighting and signage
• Implement appropriate fall protection measures 
• Ensure that proper housekeeping is done regularly to remove trip hazards
• Promptly address slip hazards, such as ice, spills, and damaged flooring. Use signage to warn persons about these hazards if they cannot be immediately controlled 
• Ensure walkways, stairs, parking lots, and other floor surfaces have adequate traction, are properly maintained, and are safe to walk on
• Train workers how to identify and control hazards that could result in blows to the head or shaking the brain. Workers are required to report all hazards so that preventive measures can be put in place by the employer
• Develop a violence prevention program and take other measures to ensure workers are protected from physical violence
• Develop a vehicle safety program and train workers on safe driving practices
• Wear a suitable, properly fitted protective headwear that complies with a recognized safety standard, such as CSA-Z94.1 Industrial protective headwear — Performance, selection, care, and use. Headwear does not prevent a concussion, but it may reduce the severity of the injury
• Wear appropriate footwear that provides good traction and is suitable for the potential hazards

Train workers on the following:

• The signs and symptoms of a concussion
• The importance of reporting a concussion, as well as how to report and to whom
• The concussion protocol, including policies and procedures on how to prevent concussions and how to respond to a potential concussion-causing incident

It is important to seek guidance from a healthcare professional on how to properly manage a concussion. 

Consider the following tips for responding to a concussion (or suspected concussion):

• A worker who is suspected of having a concussion should stop what they are doing and immediately report it to their supervisor. A worker who cannot safely perform their duties should not be allowed to do so. Safe transportation should be arranged for the worker to seek medical guidance as soon as possible. 
  • If a worker is rendered unconscious, call 911 immediately. Basic principles of first aid and cardiopulmonary resuscitation (CPR) should be followed. Do not move them or take any unnecessary actions that could cause further injury
  • Workers experiencing more serious symptoms of a concussion (double vision, severe headache, etc.) should receive medical care immediately, either by calling 911 or arranging immediate transportation to see a medical doctor
  • A worker experiencing the typical symptoms of a concussion (headache, dizziness, nausea, etc.) should still see a doctor for medical attention and guidance as soon as they can
• If a worker suffered a concussion at work, conduct an incident investigation to address the root causes of the incident
• Comply with the reporting requirements for your jurisdiction (such as to the regulator or workers’ compensation)

Consider the following tips for concussion management and recovery:

• Prioritize brain health. For example, a worker who thinks they might have a concussion should know how and be encouraged to report it and take recovery measures. Time away from work and workers’ compensation may be necessary
• Take steps to prevent additional concussions. For example, the affected worker may perform different duties that have no risk of brain trauma. Repeated brain trauma could lead to long-term issues such as chronic traumatic encephalopathy (CTE)
• Get medical clearance before returning to regular duties. A worker who suffered a concussion should take the necessary time away from work as needed for recovery, and not return too soon
• Develop a process for returning to work after a concussion as part of your organization's overall return-to-work program. The process will involve collaboration with workers and healthcare professionals. This will initially involve rest, with a gradual return to regular duties based on symptoms, observations, worker feedback, and medical clearance. Recovery after a concussion can be different for each person; therefore, progress and symptoms need to be followed closely, with the necessary accommodations being made. Workers can also experience post-concussion syndrome, where symptoms can last longer than expected. For this reason, timelines for returning to regular duties are determined on a case-by-case basis.    

More information is available from other organizations*, such as:

• Public Health Agency of Canada (PHAC): Concussion: Symptoms and treatment
• Parachute Canada: Concussion

(*We have mentioned these organizations as a means of providing a potentially useful referral. You should contact the organization(s) directly for more information about their services. Please note that mention of these organizations does not represent a recommendation or endorsement by CCOHS of these organizations over others of which you may be aware.)