How to Recognize & Assess Concussions


A person does not need to be knocked out (lose consciousness) to have had a concussion. Common symptoms include:

  • Headaches or head pressure
  • Dizziness
  • Nausea and vomiting
  • Blurred or fuzzy vision
  • Sensitivity to light or sound
  • Balance problems
  • Feeling tired or having no energy
  • Nothing thinking clearly
  • Feeling slowed down


  • Easily upset or angered
  • Sadness
  • Nervousness or anxiety
  • Sadness
  • Nervousness or anxiety
  • Feeling more emotional
  • Sleeping more or sleeping less
  • Having a hard time falling asleep
  • Difficulty working on a computer
  • Difficulty reading
  • Difficulty learning new information


Visual signs of a concussion may include:

  • Lying motionless on the playing surface
  • Slow to get up after a direct or indirect hit to the head
  • Disorientation or confusion or inability to respond appropriately to questions

  • Blank or vacant stare
  • Balance, gait difficulties, motor incoordination, stumbling slow labored movements
  • Facial injury after head trauma
  • Clutching head


If your child shows any of the following Red Flag Symptoms call 911 immediately:

  • Neck pain
  • Increased confusion or irritability
  • Repeated vomiting
  • Seizure or convulsion
  • Weakness in arms/legs
  • Tingling or burning in arms/legs
  • Deteriorating consciousness
  • Loss of consciousness
  • Severe or increasing headache
  • Unusual behaviour change
  • Double vision


CRT 5- Concussion Recognition Tool 5th Edition

SCAT 5- Sport Concussion Assessment Tool 5th Edition (for use by medical professionals)

C-SCAT 5- Child Sport Concussion Assessment Tool 5th Edition (for use by medical professionals)


  1. ON SITE MEDICAL ASSESSMENT – Depending on the suspected severity of the injury, an initial assessment may be completed by emergency medical professionals or by an on-site licensed healthcare professional where available. In cases where a participant loses consciousness, or it is suspected a participant might have a more severe head or spine injury, Emergency Medical Assessment by emergency medical professionals should take place (see 2 below). If a more severe injury is not suspected, the participant should undergo Sideline Medical Assessment (see 3 below) or Medical Assessment, (see 4 below) depending on if there is a licensed healthcare professional present.
  2. EMERGENCY MEDICAL ASSESSMENT – If a participant is suspected of sustaining a more severe head or spine injury during a competition or activity, an ambulance should be called immediately to transfer the patient to the nearest emergency department for further Medical Assessment.Water Ski and Wakeboard Canada Stakeholders should not make any effort to remove equipment or move the participant until an ambulance has arrived and the participant should not be left alone until the ambulance arrives. Due to the additional complexity of conditions on the water and the additional threats to the participants that environment may cause, there may be a need for Water Ski and Wakeboard Canada Stakeholders to enter the water and assist the injured participant to avoid imminent dangers. (i.e. drowning) Ideally, this will be handled by individuals trained in water rescue. An attempt should be made to always stabilize the cervical spine during a water rescue. After the emergency medical services staff has completed the Emergency Medical Assessment, the participant should be transferred to the nearest hospital for Medical Assessment. In the case of youth (under 18 years of age), the participant’s parents or legal guardian should be contacted immediately to inform them of the participant’s injury. For participants over 18 years of age, their emergency contact person should be contacted if one has been provided.

    WHO: Emergency medical professionals.

  3. SIDELINE MEDICAL ASSESSMENT: If a participant is suspected of sustaining a concussion and there is no concern for a more serious head or spine injury, the participant should be immediately removed from the water or activity and competition area for further assessment and determination of the next steps as detailed in the scenarios below.Scenario 1: If a licensed healthcare professional is present
    The participant should be taken to a quiet area and undergo Sideline Medical Assessment using the Sport Concussion Assessment Tool 5 (SCAT5) or the Child SCAT5. The SCAT5 and Child SCAT5 are clinical tools that should only be used by a licensed medical professional that has experience using these tools. It is important to note that the results of SCAT5 and Child SCAT5 testing can be normal in the setting of acute concussion. As such, these tools can be used by licensed healthcare professionals to document initial neurological status but should not be used to make sideline return‐to-sport decisions in youth participants. Any youth participant who is suspected of having sustained a concussion must not return to the water or activity and should be referred for Medical Assessment.


    If a youth participant is removed from the water or activity following a significant impact and has undergone Sideline Medical Assessment, but there are NO visual signs of a concussion and the participant reports NO concussion symptoms then the participant can be returned to the water or activity, but should be monitored for delayed symptoms.

    In the case of national team athletes (age 18 years and older) who have been removed from play following a suspected concussion, an experienced certified athletic therapist, physiotherapist or medical doctor providing medical coverage for the sporting event may make the determination that a concussion has not occurred based on the results of the Sideline Medical Assessment. In these cases, the athlete may be returned to the water or activity without a Medical Clearance Letter, but this should be clearly communicated to the coaching staff.

    Athletes that have been cleared to return to the water or activity should be monitored for delayed symptoms by the licensed healthcare professional. If the athlete develops any delayed symptoms the athlete should be removed from the water or activity and undergo Medical Assessment by a medical doctor or nurse practitioner. 

    Scenario 2: If there is no licensed healthcare professional present
    The participant should be referred immediately for Medical Assessment by a medical doctor or nurse practitioner, and the participant must not return to the water until receiving medical clearance.

    WHO: Athletic therapists, physiotherapists, medical doctor

    Sport Concussion Assessment Tool – 5th Edition (SCAT5)
    Child Sport Concussion Assessment Tool – 5th Edition (Child SCAT5)

  4. MEDICAL ASSESSMENT – In order to provide comprehensive evaluation of participants with a suspected concussion, the medical assessment must rule out more serious forms of traumatic brain and spine injuries, must rule out medical and neurological conditions that can present with concussion‐like symptoms, and must make the diagnosis of concussion based on findings of the clinical history and physical examination and the evidence-based use of adjunctive tests as indicated (i.e. CT scan). In addition to nurse practitioners, the types of medical doctors that are qualified to evaluate patients with a suspected concussion include2: pediatricians, family medicine, sports medicine, emergency department, internal medicine and rehabilitation (physiatrists) physicians, neurologists, and neurosurgeons.In geographic regions of Canada with limited access to medical doctors (i.e. rural or northern communities), a licensed healthcare professional (i.e. nurse) with pre‐arranged access to a medical doctor or nurse practitioner can facilitate this role. The medical assessment is responsible for determining whether the participant has been diagnosed with a concussion or not. Participants with a diagnosed concussion should be provided with a Medical Assessment Letter indicating a concussion has been diagnosed. Participants that are determined to have not sustained a concussion must be provided with a Medical Assessment Letter indicating a concussion has not been diagnosed and the participant can return to school, work and sport activities without restriction.WHO: Medical doctor, nurse practitioner, nurse
    HOW: Medical Assessment Letter


    Note – Medical doctors and nurse practitioners are the only healthcare professionals in Canada with licensed training and expertise to meet these needs; therefore, all participants with a suspected concussion should undergo evaluation by one of these professionals



Coaches and Trainers:

Parents and Caregivers: