Second Impact Syndrome

SIS is caused by a second physical impact, in a close period of time (minutes, days, weeks) after  the symptoms from prior concussion have subsided. It is caused by rapid and extreme swelling in the brain, which can often be fatal, lead to severe disability or coma. The patient feels signs of concussion after the first head injury such as headaches, visual, sensory or motor changes and especially recognised is effect on memory. Although the symptoms may subside quickly, the effect of swelling on the brain takes a long time to reduce. If the athlete continues playing, and experiences a second impact they appear stunned but do not have loss of consciousness, however after seconds to minutes the athlete collapses, semi-conscious with dilating pupils, loss eye movement and stops breathing.

The cause is thought to be due to the brain’s arterioles losing their ability to regulate the diameter, therefore lose control over cerebral blood flow, causing massive cerebral edema. Cerebral edema is when there is an excess accumulation of fluid within the intracellular or extracellular brain spaces. With an increase in water content in the brain, the pressure within the skull rises . For this reason it is considered an medical emergency because blood vessels can become compacted, and hence oxygen supply limited.  In serious cases herniation is thought to occur, which is leads to decreased blood flow in the brain because with an increase in pressure the brain is squeezed through small holes within the skull.

The vast majority of cases occur within males under the age of eighteen, because their brains are still developing so the symptoms of concussion take longer to subside. Two years ago, Benjamin Robinson, 14 died during a rugby match from Second Impact Syndrome. His parents are campaigning to have new legislation put in place to protect further incidences occurring in Ireland and the UK.  For Example in the National Football League in America, players diagnosed with concussion during the game were not allowed to continue playing and are subjected to testing over the following days to determine if the player is fit to play the next match.

References:

http://www.momsteam.com/health-safety/concussion-safety/general/second-impact-syndrome-signs-and-symptoms

http://health.howstuffworks.com/mental-health/neurological-conditions/cerebral-edema.htm#

http://en.wikipedia.org/wiki/Second-impact_syndrome

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672291/

http://www.dailymail.co.uk/news/article-2410391/Rugby-player-14--died-second-impact-syndrome-playing-rugby-25-minutes-heavy-collision-player.html

Francis Report

In February of this year, the final report of the Mid Staffordshire NHS Foundation Trust Public Inquiry was published after Andrew Lansley; the secretary of state for health announced the need for a full public inquiry in June 2010.  The full public inquiry investigates the role of the commissioning, supervisory and regulatory bodies in the monitoring of Mid Staffordshire Foundation NHS Trust. The inquiry is chaired by Robert Francis, who will make recommendations to the secretary of state for health. It will consider why the serious problems between January 2005 and March 2009 at the Trust were not identified and acted on sooner, and will identify important lessons to be learnt for the future of patient care.

Structure of the inquiry

The Inquiry follows the requirements of the Inquiries Act 2005 and the Inquiry Rules 2006.  Key tasks are:

 - Gathering and reviewing evidence, including the taking of witness statements – this began in July 2010; following the conclusion of the hearings, new evidence is now only accepted on an exceptional basis

- Oral hearings – these began on 8 November 2010 in Stafford and concluded on 1 December 2011

- Writing the final report

In addition, the Inquiry held a series of seven seminars in October and November 2011, to explore the 'forward-looking' part of the Inquiry's terms of reference. The Inquiry's hearings were held at Stafford Borough Council's offices, at the Riverside in Stafford. This is because they aimed to hold them as close to the people affected most, but also allowing them to be carried out efficiently and effectively, considering the cost and meet the needs of other interested parties. The Chairman has also undertaken a number of visits to observe and identify examples of good practice and provide him with some context in relation to NHS healthcare provision.

This public inquiry differs from the previous independent inquiry set up under the NHS Act 2006.  The Chairman is required to take such steps as he thinks reasonable to secure public access to the hearings and evidence taken by the Inquiry.  He may also compel people to give evidence and has powers to require production of evidence to the Inquiry. However the focus of the first inquiry was to look at individual cases of patient care, or specifically at the internal operation of the Trust. 

After the inquiry, the report was published on 6 February 2013 and makes 290 recommendations, including:
 •openness, transparency and candour throughout the healthcare system (including a statutory duty of candour), fundamental standards for healthcare providers
 •improved support for compassionate caring and committed nursing and stronger healthcare leadership.

References:

http://www.midstaffspublicinquiry.com/

http://www.health.org.uk/areas-of-work/francis-inquiry/about-the-francis-inquiry/