What is Second Impact Syndrome?

Second Impact Syndrome occurs when a person suffers a second concussion before the symptoms of the first one have subsided. Specifically, in this condition the brain swells rapidly and catastrophically. Sometimes, even fatally. At least 50% of people with Second Impact Syndrome die, and 100% are permanently impaired. 

Once a first concussion had been sustained, the brain becomes much more sensitive to further damage. In fact, if the victim has not yet recovered from the first concussion, a shake, mild blow, or fall, even without a direct hit to the head, can start the process of Second Impact Syndrome. This is why WHEN IN DOUBT, SIT IT OUT is so important. If there is any possibility of a concussion, it is critical to avoid a second impact of any kind.   

Preventing Second Impact Syndrome

Our athletic trainers work with local schools to establish and enforce a protocol requiring at least seven days off from contact sports following an initial concussion. This allows time for the brain to heal, reducing the risk for a second concussion. For this reason, Jenna’s Law, an extension of Max’s Law, legislated against immediate return to play after a concussion. The result is a marked decrease in the number of students developing Second Impact Syndrome. In fact, Second Impact Syndrome is now extremely rare, thanks to greatly improved concussion recognition and care. 

References

Robert C. Cantu, SECOND-IMPACT SYNDROME, Clinics in Sports Medicine, Volume 17, Issue 1, 1998, Pages 37-44, ISSN 0278-5919, https://doi.org/10.1016/S0278-5919(05)70059-4. (https://www.sciencedirect.com/science/article/pii/S0278591905700594) 

Martineau, Chad PA-C, ATC; Kingma, Jackie J. MS, ATC, PA-C, PT; Bank, Laura PhD, PA-C; McLeod, Tamara C. Valovich PhD, ATC Guidelines for treatment of sport-related concussions, Journal of the American Academy of Physician Assistants: May 2007 – Volume 20 – Issue 5 – p 22-28 

Bey, MD, T., Ostick, MD, B. (2009). Second Impact Syndrome. West J Emerg Med. 2009 Feb; 10(1): 6–10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672291/ 

Concussions occur routinely during the activities and accidents of daily life. However, concussion in sports gets the most media attention by far. This is not without reason. In fact, each year there are between 1.6 and 3.8 million reported sports-related concussions. And, those numbers could be much higher. Alarmingly, estimates show that up to 80% of athletes sustain concussions without being aware of their injury. This means that as many as 80% of sports-related concussions go unreported. This is often because of a lack of awareness and education regarding concussions in sports. Combined with the risk associated with participating in sports while still recovering from a concussion, this is concerning.

Youth concussions in sports

Understandably, concussions in professional sports, especially football, get a lot of media attention. Likewise, concussions in youth sports is an equally important topic. Specifically, concussions account for approximately 3-8% of all sports-related emergency room visits for youth. Additionally, data suggests that concussions account for 8.9% of all high school sports injuries. Compared to 6% in college sports, this indicates a possible increased risk of concussion in younger athletes. 

Fortunately, most youth recover relatively quickly from concussion injuries. However, in some cases, recovery is more prolonged. In fact, evidence suggests that youth are both more susceptible to concussions and take longer to recover than older athletes. These factors, coupled with concerns over undeveloped young brains, highlight the importance of education and awareness of the recognition, evaluation, and treatment of concussions in youth sports. 

Risk by sport

All sports carry the risk of concussion. That being said, there are higher and lower risk sports. Specifically, approximately 20% of concussions happen in contact sports, which are higher risk. Important to note, about 80% occur in non-contact, or lower risk, sports. National data shows that the sports with the highest incidence of concussion are rugby, hockey, and football. Conversely, the lowest incidence of concussion are in volleyball, baseball, and cheerleading. Locally, data from our athletic trainers at Central Oregon high schools show the highest rate of concussions in football, girl’s soccer, and girl’s basketball. 

Managing sports-related concussions

Our athletic trainers are experts trained in recognition, evaluation, treatment, and management of sports-related concussions. As essential members of risk management and concussion prevention teams, they are present whenever high school sports are played. Our athletic trainers work diligently to implement the established concussion protocol and oversee the safe return-to-play for injured athletes. They ensure that young athletes do not return to sports too soon, reducing the risk of recurrent concussion. We are proud that the concussion protocols we have established with local schools demonstrate only a 6% risk of recurrent or repeat concussion – a more than 2% reduction from national standards. 

References

Martineau, Chad PA-C, ATC; Kingma, Jackie J. MS, ATC, PA-C, PT; Bank, Laura PhD, PA-C; McLeod, Tamara C. Valovich PhD, ATC Guidelines for treatment of sport-related concussions, Journal of the American Academy of Physician Assistants: May 2007 – Volume 20 – Issue 5 – p 22-28. 

Sports-Related Concussions in Youth: Improving the Science, Changing the Culture. Committee on Sports-Related Concussions in Youth; Board on Children, Youth, and Families; Institute of Medicine; National Research Council; Graham R, Rivara FP, Ford MA, et al., editors. Washington (DC): National Academies Press (US); 2014 Feb 4. https://www.ncbi.nlm.nih.gov/books/NBK185340/#__NBK185340_dtls__ 

Pfister, T., Pfister, K., Hagel, B., Ghali, W. and Ronksley, P. (2015). The incidence of concussion in youth sports: a systematic review and meta-analysis. British Journal of Sports Medicine, 50(5), pp.292-297. https://pubmed.ncbi.nlm.nih.gov/26626271/ 

Concussion symptoms in kids

Concussion symptoms in kids are the same as for older children and adults. However, very young children are often unable to name or talk about their symptoms in the same way an older child or adult can. Therefore, it is important to watch your child carefully after an injury to look for signs and symptoms of a concussion. If your child shows any symptoms of a possible concussion after a hit to the head or blow to the body, it is crucial to remove them from play immediately. Furthermore, they should not return to play until they have been evaluated and cleared by a trained healthcare provider. 

Most children recover from concussions relatively quickly. However, in some cases recovery can be much slower. Many people wrongly assume that a child must be “knocked out” or lose consciousness in order to sustain a concussion. In fact, only 10% of kids with concussions are “knocked out.” Therefore, this should not be relied on as an indicator of whether a child did or did not sustain a concussion. 

Since young children and babies are not able to communicate their symptoms in the same way an adult or older child can, it is important that an adult watch for signs that indicate a possible concussion. If your child does not appear to be improving after a hit to the head, you should call your doctor or seek medical care. 

“Concussions can be serious injuries if not treated properly. Symptoms can affect players in all areas of their lives including their physical, emotional, and cognitive functioning. Swift and appropriate evaluation by trained sports medicine professionals is crucial before an athlete returns to play. That is why we counsel students and coaches to err on the side of caution and ‘when in doubt, sit out.’” 

—Ruben Echemendia, PhD, NAN past president and director of the NHL’s Neuropsychological Testing Program 

Symptoms in kids

• Excessive crying and/or cannot be consoled 

• Headache that does not go away 

• Change in the way that they play or act 

• Change in eating, sleeping, or nursing pattern 

• Becomes upset more easily than normal or abnormal temper tantrums 

• Appears sad or depressed 

• Lack of interest in normal activities 

• Appears unsteady or loses balance easily 

If your child experiences any of the following RED FLAG symptoms, you should call your doctor or go to the emergency department IMMEDIATLEY.

• Headache that progressively worsens 

• Seizure 

• Slurred or “drunken” speech 

• Increasing confusion 

• Repeated vomiting 

• Unequal pupils 

• Can’t recognize people or places 

• Looks very drowsy, or can’t be awakened 

• Weakness or numbness in arms or legs 

• Unusual behavior 

• Increasing irritability 

• Loses consciousness 

Symptoms of concussion 

When thinking about symptoms of concussion, it is helpful to divide them into two categories – symptoms reported by the injured person, and those observed by parents, teammates, or coaches. Importantly, the injured person is often not aware of the symptoms that others can see. In addition, while symptoms usually show up immediately, sometimes they can take a few hours or days to fully appear and develop.

Reported symptoms

• Headache or feeling of pressure in the head 

• Nausea or vomiting 

• Dizziness or trouble keeping your balance 

• Double or blurry vision 

• Sensitivity to light or noise 

• Feeling slowed down 

• Confusion or difficulty concentrating or remembering things 

Observed symptoms

• Can’t recall events just before or after the incident 

• Appears dazed or stunned 

• Appears confused or forgetful 

• Moves clumsily 

• Responds slowly to questions 

• Gets knocked out or loses consciousness 

• Mood, behavior, or personality changes 

Remember, if you or your child experience any of the following RED FLAG symptoms, call your doctor or go to the emergency department IMMEDIATELY. 

• Headache that gets worse over time 

• Seizure 

• Slurred or “drunken” speech 

• Increasing confusion 

• Repeated vomiting 

• Unequal pupils 

• Can’t recognize people or places 

• Looks very drowsy, or can’t be awakened 

• Weakness or numbness in arms or legs 

• Unusual behavior 

• Increasing irritability 

• Loses consciousness 

It is important to note that the symptoms of concussion are generally the same for children and adults. However, very young children may not be able to report a symptom the same way an older child can. 

St. Charles Health System’s Trauma Program will honor and recognize former trauma patients Wednesday, May 21 at St. Charles Bend. The event will include a visit from therapy dogs, free barbecue lunch and the chance to connect with St. Charles caregivers, first responders and fellow medical trauma survivors.

“Every year this is an incredible event for our former patients and caregivers. It’s a chance to connect with one another in a meaningful and healing way,” said Jeremy Buller, Trauma Program Coordinator.

The event will take place from 11 a.m. to 1 p.m. in the St. Charles Bend Conference Rooms A and B and the outside patio, weather permitting.

St. Charles Trauma and Emergency Services cared for more than 2,500 traumatically injured patients in 2024 – up about 200 patients over the previous year. Falls are the most common injury, followed by motor vehicle crashes, ATV/snowmobile/dirt bike crashes, motorcycle crashes and bike crashes.

Buller said that summer is referred to as trauma season by medical professionals because of an increase in these types of injuries.

“We are always here and ready to help, but we would also love to help our community members prevent a visit to the Emergency Department,” said Buller. “Have fun this summer, but please wear a helmet, don’t mix intoxicants with moving vehicles, don’t text and drive and talk to your primary care doctor about fall prevention.”

The St. Charles Blossom Project is a simple yet meaningful way to bring comfort, joy and beauty to hospice families in Central Oregon. A small act of kindness with a big impact: bringing flower donations to help brighten the days of hospice and palliative care patients during their end-of-life care.

The volunteer team creates nearly 325 bouquets each month, which are delivered to hospice families throughout Warm Springs, Madras, Redmond, Bend, Sisters, La Pine and Prineville. Deliveries take place six days a week, ensuring they always reach people when they need them the most.

“Hospice has a such a special place in my heart after having multiple of my own family members go through it,” said Lisa DeBraal, a volunteer for the St. Charles Blossom Project. “Volunteering is a meaningful way for me to give back to these patients and families as they go through a challenging time.  It’s so rewarding to see how much these flowers brighten their days.”

This program first began as the Bloom Project, a nonprofit organization that provided fresh floral arrangements to hospice and palliative care patients for over 13 years. When they closed their doors in December of 2019, a group of dedicated volunteers decided to carry on this mission through St. Charles Hospice. With a new name and the same compassionate spirit, they continue spreading kindness through flowers.

Today, the St. Charles Blossom Project continues to serve patients across Central Oregon. A team of 35 volunteers collect fresh flowers daily thanks to donations from Safeway, Trader Joe’s and Newport Market. These flowers are then repurposed into beautifully arranged bouquets by the hospice blossom volunteers.

The project also benefits local palliative care facilities like Aspen Ridge Memory Care in Bend, where residents use the flowers to create their own arrangements to display in their dining room.

“Our residents truly look forward to the weekly flower deliveries,” said Deena Newman, Life Enrichment Director at Aspen Ridge Memory Care. “It’s such a meaningful way to brighten our space and always brings a smile to their faces.”

If you recently hit your head, you might be wondering, “Do I have a concussion?” If you experience any of the signs and symptoms, or just don’t feel right after a hit to the head or body, you may have a concussion. 

It is important to seek medical attention if you think you or your child may have a concussion. 

The content on this site is not intended to be a substitute for professional medical advice, diagnosis, or treatment. 

Symptoms of concussions are classified into four different categories; physical, mental, emotional, and sleep. This means that there are many different ways that concussions can affect you. Therefore, it is important to know all of the possible symptoms. In fact, many people think that they don’t have a concussion because they weren’t knocked out, and don’t have a headache or dizziness. However, those are just a few of the many possible symptoms of concussions. The table on this page will help you understand the different symptoms by category.

If you observe any of the following, seek immediate medical attention!

If it’s possible you have a concussion, but you’re not sure, it is best to stop physical activity until you get evaluated by a competent healthcare professional. Sitting out for one practice or game to make sure that you are okay, is better than trying to push through a potential concussion and continue to play. Research shows that when you don’t report a possible concussion and continue to play sports, you may slow your recovery. Ultimately, you could end up sitting out much longer by not taking a break and reporting the injury immediately.

So, do I have a concussion?

As you can see, there are many possible symptoms that could be associated with concussions. Ultimately, it is best not to self-diagnose. Again, if you experience any of these symptoms, or just don’t feel right after a hit to the head, get medical care. Your athletic trainer or other healthcare professional will help ensure that you are okay and it is safe to resume sports or other physical activity. 

When dealing with a possible concussion, it is best to see a healthcare professional trained in the evaluation, diagnosis, and treatment of concussions. You will receive a detailed evaluation, including a history of the incident and a review of your symptoms. In addition, they will assess your mental function and perform a complete neurological exam. This helps to determine whether or not you have a concussion. Next, you will get a recommend treatment program designed for the specific symptoms that you are experiencing. The goal is to give you the best environment to recover from your injury. 

Learn more about concussion testing and concussion protocol.

References 

Sports-Related Concussions in Youth: Improving the Science, Changing the Culture. Committee on Sports-Related Concussions in Youth; Board on Children, Youth, and Families; Institute of Medicine; National Research Council; Graham R, Rivara FP, Ford MA, et al., editors. Washington (DC): National Academies Press (US); 2014 Feb 4. https://www.ncbi.nlm.nih.gov/books/NBK185340/#__NBK185340_dtls__ 

A concussion is a mild traumatic brain injury, or mTBI. We no longer use the old grading system (grade I, II, or III) to identify types of concussion. The grading system used factors present at the time of injury, such as whether the individual lost consciousness or not. A concussion should never be minimized just because the individual did not lose consciousness. In fact, only about 10% of individuals lose consciousness when they sustain a concussion. All concussions are serious brain injuries and should be treated as such.

Understanding types of concussions

Generally, concussion diagnosis is simply yes or no, with no grading or degree. This is because no two concussions are the same and each individual experiences a concussion differently. In short, the number of symptoms, intensity of symptoms, and the time it takes to recover are what determine the severity of a concussion. In some situations, an individual with relatively mild symptoms may take a long time to recover. Conversely, an individual with severe symptoms may recover relatively quickly. For this reason, physicians often do not classify a concussion until after the individual has fully recovered.

Additionally, doctors consider how the concussion affects the individual’s ability to perform normal daily activities. If symptoms interfere with the ability to go to school or work, especially over an extended period of time, the injury may be considered severe. While most concussions resolve within a month, symptoms can last much longer for some people. This is sometimes referred to as post-concussion syndrome. Although not common, individuals who have a history of multiple concussions or have a repeat injury are at a greater risk of post-concussion syndrome.

Proper care for all types of concussions

Our concussion protocol reduces the risk of repeat concussions and Second Impact Syndrome. It accomplishes this by ensuring that athletes do not return to sports too soon following injury. Additionally, for those who are dealing with more significant injury, it includes steps to provide necessary treatment specific to the issues they are dealing with. Whether they need accommodations in the classroom, have symptoms of depression or other emotional disturbances, or physical issues such as balance, vision, or headaches, following our concussion protocol ensures that proper care is provided regardless of the type or severity of injury.

Get your child back in the game, safely

We are passionate about getting Central Oregon youth the care they need when they have experienced a concussion. To this end, we follow a research-based model of management in treating concussions. Like you, our focus is on getting your child healthy and safely returning them to the activity they love. 

Additionally, we strive to provide the most current concussion information on these pages. However, if you do not find what you are looking for here, please contact us. 

This content is not intended to be a substitute for professional medical advice, diagnosis or treatment. 

There is a lot of uncertainty in the country and in the health care industry these days. 

In particular, proposed budget cuts at the federal level could have wide-ranging impacts on Medicaid, Medicare and other important programs. Other cuts enacted in the past few months are impacting many of our fellow health care organizations in terms of funding for research and grant-based programs. 

Increasingly, community members are reaching out with concern about these changes and asking for my thoughts on the impacts we may experience locally. 

We are keeping a close eye on the evolving situation, but so far St. Charles has not experienced direct cuts. We are working with our elected officials to protect what we can at the local level and we are grateful to the Oregon Legislature for moving swiftly this session to renew the provider tax that helps fund Medicaid for Oregonians. 

And yet, three out of four patients we serve are covered by Medicare or Medicaid, and those programs chronically underpay providers. Medicaid reimburses hospitals about 70 cents for every dollar of care we provide. Oregon hospitals are struggling financially, with nearly all health systems reporting financial losses in 2024 and additional losses in the first quarter of 2025. With a 0.6% operating margin, St. Charles was barely in the black at the end of last year. We are celebrating this small accomplishment, but we know that a healthy operating margin needs to be closer to 5% long term so we can continue investing in our people, places and programs. Sizeable federal budget cuts will inevitably impact care in our region. It is just too soon and too speculative at this moment to know by how much.

Meanwhile, as Central Oregon continues to grow, St. Charles has a responsibility to also expand the care we provide. This past year, we have invested in new services including gastroenterology, urology, orthopedics, neurosurgery, physiatry and more. And we anticipate more investment will be needed over the next few years to upgrade our facilities to meet the community’s needs. We know our emergency rooms and operating suites are not adequate for today’s population, for example, and we are working to address those issues. But planning for and building new health care facilities takes a significant amount of time and resources – and quite frankly, cuts to our already limited reimbursements won’t help us get there. 

So, for now, we are focusing on what we can control: Supporting our more than 5,000 caregivers and ensuring that we continue providing exceptional care. We have a solid long-term plan that focuses on growth — growth that is sustainable, responsible, prudent, and necessary. Because that’s our job as your local, nonprofit, community health system and we are proud to do it.

Thank you, as always, for your ongoing support. 

Sincerely,
Steve

Recently, St. Charles athletic trainers visited Lava Ridge Elementary in Bend as part of the Train Your Brain program.

Using a fun and interactive approach — see the beloved melon drop demonstration, pictured below — trainers taught third-graders how to protect their brains and why it’s important to wear a helmet. Students also got to take home a free helmet properly fitted by our volunteers.

As part of Train Your Brain, which became a St. Charles program upon the integration of The Center, our trainers will visit dozens of schools, train thousands of kids and give away about 1,000 free helmets.

We are excited to continue keeping Central Oregon kids safe while they bike, skate and play this summer and beyond.