Fife GP, Harter RA: Oregon State University, Corvallis, Oregon, USA

fifeg@udel.edu (541) 908-1051; rod.harter@oregonstate.edu (541) 737-6801

A Comparison of Concussion Assessment and Management Protocols Used at Elite

Taekwondo Tournaments in the Republic of Korea and the United States

Accepted for oral presentation at the 2009 Scientific Congress on Martial Arts and
Combat Sports held in Viseu Portugal

Context: In the Olympic sport of taekwondo (TKD), the incidence of concussion has
been reported to be 3 times greater than that found in American football and other
sports (Zemper and Pieter, 1994; Koh, 2004). In a martial art in which high velocity
kicks and punches to the head are essential components of TKD tournament
competition, little is known about the assessment and management protocols currently
used by medical personnel to evaluate concussions. In the USA, the National Athletic
Trainers’ Association recently published new recommendations for the management of
the concussed athlete, and has suggested protocols for medical teams to follow after the
occurrence of a concussion (Guskiewicz et. al, 2004). Objectives: To identify and
compare the concussion management and assessment protocols used by medical
personnel at TKD tournaments in the USA and the Republic of Korea (South Korea). A
secondary objective was to gain further understanding of the qualifications and
professional experience of medical personnel providing medical care at selected elite
TKD tournaments. Design: Cross-sectional qualitative survey. Setting:
Questionnaires were administered to tournament medical personnel in South Korea,
specifically, at the 41st National President’s Taekwondo Cup in 2006, the 2007 Elite
Industrial Taekwondo Championship and the 30th Korean National Collegiate
Taekwondo Championships in 2007, and in the United States at the 2008 U.S. National
Taekwondo Championships. Patients or Other Participants: Eighteen TKD
tournament medical personnel of either Korean (n = 11) and American (n = 7)
nationality. Interventions: We administered paper-and-pencil questionnaires to all
volunteers, with Korean or English language versions of the questionnaire provided as
appropriate. The questionnaire required participants to quantify the extent of their
personal experiences providing medical care at TKD tournaments, as well as indicate
the methods they currently used to assess and manage concussions. Main Outcome
Measures: We employed frequency analysis and descriptive statistics to summarize the
level of professional experience in the medical field, the number of years worked in
TKD tournament settings, and the type of medical/allied health credential that the
respondents held. Medical personnel were asked to indicate whether they used any of 10
different methods used to assess and make return-to-play decisions, e.g., ImPACT,
Sideline Assessment of Concussion (SAC) test. Results: Four of the 11 Korean medical
personnel surveyed (36%) held registered nursing (RN) credentials, while 4 were
physical therapists (PT) (36%), and 3 (27%) were emergency medical technicians
(EMTs). In comparison, the credentials of medical personnel at the 2008 U.S. National
Taekwondo Championships included 2 physicians (29%), 2 certified athletic trainers
(ATCs) (29%), 2 EMTs (29%), and 1 PT (14%). Of the South Korean respondents, 55%
(n = 6) had less than one year of experience serving as medical care provider at TKD
tournaments, with 46% of participants (n = 5) indicating that the tournament in which
this survey was conducted was the first time he/she provided medical coverage at a
TKD tournament. Five of 7 (71%) American respondents indicated that they had > 5
years experience serving as medical personnel at TKD tournaments, with 4 of 7
reporting that they had > 10 years experience at national level TKD tournaments. Six
of the Korean medical personnel (55%) reported treating < 2 concussions at TKD
tournaments within the past year. Four of 7 (57%) American medical personnel
surveyed indicated they had provided care for an average of 15 concussions at TKD
tournaments within the past year; the remaining medical staff provided care for an
average of 3 concussions within the past year. All South Korean and American medical
personnel reported using two or more concussion assessment protocols, e.g., symptoms
checklist, clinical evaluation. Conclusions: The taekwondo tournament medical
personnel in South Korea and the USA who were surveyed encountered substantially
different numbers of concussions during elite TKD tournaments, a result that may be
partially explained by differences in medical training and years of experience between
the groups. We recommend that TKD national governing bodies assign only medical
personnel who have direct, significant work experience with the sport of TKD to
provide medical care at national-level taekwondo tournaments. Given the recent
worldwide concern about long-term consequences for athletes who have sustained
multiple concussions, TKD national governing bodies would do well to review current
concussion management and assessment protocols used by medical personnel in their
countries, and identify a standard of care for concussion assessment and management
that accommodates the unique physical and neurocognitive demands placed on national-
level taekwondo tournament competitors.