Can local football handle concussion care?

As the AFL investigates concussion care procedures, Louie Cina investigates how community clubs are meeting new guidelines.

For Queenslander Maddy Riddle, her first season playing Australian Rules Football since moving to Melbourne could not have gone much better. Playing for AJAX in the Victorian Amateur Football Association’s Division 3 Women’s competition, her side had soared to fourth place, comfortably dispatching Oakleigh in the semi-final, and were a single match away from their first Grand Final appearance since 2019. 

The game rolled around, and Riddle, a defender, was tasked with playing on Glen Eira’s former captain. “I was going up for a mark amongst a pack… and all I remember is going up for [the] mark then being on the ground”, she recalls. In the contest, she had been knocked unconscious. “The doctors said it would have been about a ten or fifteen-second blackout”. 

Disoriented and emotional, Riddle was helped from the ground to be assessed by trainers. “I could not stop crying, more from the realisation that we were about to play in the Grand Final in six days and I was not gonna be able to be on the field, but also because I don’t have any family here in Melbourne.” 

Initially, no one realised the severity of the concussion, but fifteen minutes later, Maddy started vomiting, and the decision was made to take her to the hospital. 

This incident occurred as the AFL was cracking down on concussions following several high-profile lawsuits that highlighted a concussion crisis within the game. Big changes were made at the highest level, but for many involved with community football, questions remained about whether their level of play was properly equipped to handle player safety. 

After Riddle was discharged, her symptoms continued to persist. “It took probably around two months until my energy levels were back…I wasn’t able to go back to work until Thursday. The incident happened on Saturday, and I wasn’t able to look at screens and properly focus or comprehend things for quite a few days.”

Maddy Riddle suffered a bad concussion that she believes may not have been initially dealt with as seriously as it should have been. (Image: Louie Cina)

These have since subsided, but the situation changed the way Riddle plays the game. “I still am [hyperaware of contact to the head]... eighteen months on. It’s definitely still a factor, especially when going up from a mark, because that was the specific motion that [the concussion] occurred in, [I’m] definitely a bit more hesitant doing that kind of activity.”

But for some players, the symptoms post-concussion don’t improve. 

Nicci Villo was playing local football for the Darebin Falcons in the Northern Football Netball League in May of 2024 when she suffered what she describes as a “pretty hectic concussion.” 

“Apparently, I lost consciousness for a couple of minutes… some people said that I was unconscious before I actually hit the ground,” she recounts. “As I was disposing of the ball and as that head knock happened… I actually went into the ground head first, so it was like two at once.” 

“I know the trainers that were on were pretty experienced [and] dealt with it quite well from what I’ve been told, and also one of the girls in the team at that time was a paramedic, so it helped to have that.” Despite the level of care she received, Villo has had consistent trouble with symptoms ever since. 

“I never used to get migraines, but now I do. I never really had headaches, now I get headaches at least once a fortnight… I can be slower when I get fatigued or overstimulated, and that never used to be the case.” 

The incident and the continuing symptoms ruled Villo out not just for the remainder of the 2024 season, but the following year as well. This led her to develop an interest in concussions and getting qualified as a Level One Sports Trainer to maintain a connection with the club she used to play for. 

As Villo’s club plays in the NFNL and is not considered to be competing in a tier one competition (state league or higher), for a game to go ahead, the Australian Rules National Football Policy Handbook only requires there to be two “AFL First Aiders” on hand to provide medical support. To be considered an AFL first aider, a person must have completed a nationally accredited first aid and CPR course, and the AFL’s First Aid and Concussion Online Module within the last two years. This module is just forty minutes long.

Whilst the handbook recommends that each club has at least a Level One Sports Trainer on hand, games can go ahead with just the two AFL First Aiders. This means that, in theory, the only medical support on hand at a local football game could be two people who have completed a single first aid course and a forty-minute online module each. 

Villo herself is a Level One Sports Trainer, meaning she has completed a more comprehensive, controlling-body-approved Level One Sports Trainer course as well as the online first aid and concussion module. She, alongside Maddy Riddle, feels that the minimum requirements do not necessarily adequately prepare AFL First Aiders to deal with concussion. 

Sports Trainer Nicci Villo thinks the minimum requirements may not be adequate in equipping AFL First Aiders to deal with something as serious as a concussion. (Image: Louie Cina)

“Sometimes in those heat-of-the-moment situations [with a concussion], it’s like an exam, right? You walk into the room and then all of a sudden you forget everything,” Villo explains. “You could be there and yeah, you know how to do it, but all of a sudden you’re like ‘Oh my god, what am I supposed to do here?’”

Delaksha Kusalakumar, who is also a Sports Trainer at the Darebin Falcons, shares a similar sentiment, saying it’s a “little bit challenging” for someone who’s just undergone the mandatory AFL First Aider training to be in a position where they’re best able to provide care for a player with a suspected concussion. 

She did credit the program for its promotion of the HeadCheck app, a tool that helps identify and manage suspected concussions during the sort of stressful situations Nicci Villo spoke of by asking medically based questions and offering advice on the removal of the player from the ground, subsequent treatment, and recovery. 

“The threshold for [a suspected] concussion is quite low”, Kusalakumar explains, “I feel like having that additional backup there has made it a lot more simple because it’s less on me… more on this tool [to decide to take the player off].”

Kusalakumar has worked as a Sports Trainer for various local football clubs as well as Hockey Victoria, and has seen firsthand the importance of measures like these, which have been introduced as concussion regulations have been strengthened throughout her short career. 

“There have been times in the past, especially where the player is older than you, where you ask them the questions you need to ask them, and they say ‘I’m fine, I’m fine!’” She recalls. “It [was] hard to overrule them when they say they’re fine… but now, it would be ‘No, answer my questions properly!’ The trainer [has] a lot more say in that situation.”

In 2024, the Australian Football League announced that it had extended the minimum exclusion period following a concussion from twelve to twenty-one days for all footballers below the professional level. Players are also required to get medical clearance before returning to full-contact training, and any repeated or long-lasting concussions must be assessed by a doctor with expertise in concussion. 

Several high-profile incidents and class action lawsuits over recent years have seen concussion protocols tightened across all levels of football, with longer exclusion periods at the local level. (Image:Louie Cina)

Whilst these measures help, Riddle, Villo, and Kusalakumar are all strong advocates for more education around concussion, especially for players. 

Karl Worner, who plays for Fremantle in the AFL and suffered a concussion in a match against Brisbane last year that saw him miss a month of football, spoke of the quality and importance of the AFL’s concussion education for its players.

The return to play process relies on the player self reporting their symptoms. Worner explained how, following his incident, he understood the potential ramifications of rushing his recovery or not being honest about his symptoms. “We have people come to speak to us about the return to play, and the effects of returning earlier.” 

“I was well across the significance of my concussion, I was well across the effects that it might have on my future self, my future playing football,” he recalled. “Knowing the sort of [information] we’d been given, it definitely helped me make the right choices in my return to play.”

In local footy given the resource gap, the education isn’t the same. Riddle spoke of a safe tackling session, and Kusulakumar and Villo of a concussion workshop run by emergency doctors involved at the Falcons, with all three in agreement that more education only will serve to better protect players, especially with the challenges of having highly trained medical staff at every local game. 

“I think [the policies and education] need to be in line with AFL and AFLW standards,” Villo says. “I think having that continuity will actually embed that value, that culture of ensuring that [the players] protect each other and protect themselves as well.”