Sergeant Checklist: The First Hour After a Suspected Concussion

The first hour after a suspected concussion is where agencies either prevent long-term harm or create it. In law enforcement, that hour rarely starts in a clinic. It starts with a sergeant on scene, a radio full of pending calls, and an officer saying they are fine. Ohio State's law-enforcement head-injury work found high lifetime exposure and major underdiagnosis, which means supervisors should assume some injuries will be minimized in real time. A consistent first-hour checklist protects the officer, the public, and the agency's legal position.

Minute 0-5: remove risk and stabilize operations

Start with operations, not paperwork. Remove the officer from any role that involves driving, firearm decision-making under pressure, foot pursuits, use-of-force contact, or solo scene management. Reassign cover units immediately so no one feels pressure to keep working while symptomatic. Supervisors should communicate clearly: this is a temporary medical hold, not discipline. That language matters because fear of career impact is a known reporting barrier and can delay care.

Minute 5-15: run danger-sign screening

Use CDC concussion danger signs as your red-flag threshold. If there is worsening headache, repeated vomiting, seizure activity, slurred speech, unusual behavior, increasing confusion, unequal pupils, new weakness, or reduced wakefulness, activate emergency transport now. Even without red flags, keep direct observation in place and avoid "walk it off" decisions. Symptoms may evolve over minutes or hours, and delayed deterioration is exactly why structured observation exists.

• Assign one supervisor or senior officer to continuous observation
• Log symptom changes with timestamps
• Prevent the officer from self-clearing back to calls
• Notify watch command and begin medical referral pathway

Minute 15-30: capture objective event details

Document the mechanism while memory is fresh: strike location, force direction, secondary impact, protective gear used, and whether there was any loss of consciousness, confusion, memory gap, or balance change. Add witness observations and body-camera references. This is not just administrative detail. It supports clinical decision-making and workers' compensation integrity, especially when symptoms become more obvious later in the shift or next day.

If your agency runs cognitive or balance baselines, record that baseline availability in the report so clinicians know a comparison exists. For implementation guidance, see police concussion baseline testing.

Minute 30-45: set temporary duty limits

Until evaluated, place the officer on non-hazard tasks only. That can include station-based admin work, evidence review, or report completion in a low-stimulation setting if symptoms permit. Avoid driving, contact operations, tactical entries, and high-noise exposure. CDC workplace guidance emphasizes that return timing and accommodations vary by symptoms and job demands; public safety roles are high risk and usually require stricter limits than desk roles.

1. No emergency driving or code response
2. No arrest team or use-of-force assignment
3. No firearms training, combatives, or breaching exposure
4. No solo field deployment until clinical clearance

Minute 45-60: formal handoff and next-day plan

End the first hour with a formal handoff: where the officer is being evaluated, who receives the report, who confirms family notification if needed, and who owns next-shift follow-up. Provide written instructions on red-flag escalation so symptoms overnight are not ignored. Supervisors should also notify command staff with concise operational language focused on safety and continuity, not assumptions about diagnosis.

When clearance questions arise, supervisors should not improvise. Use a defined process with qualified clinicians. This resource explains the medical authority question clearly: who can clear a concussion.

Why this checklist changes outcomes

In many departments, the hidden failure is not lack of concern; it is inconsistency between shifts, units, and personalities. One sergeant sends an officer to care, another tells them to hydrate and finish reports. A checklist removes that variability. It standardizes early decisions, improves clinical information quality, and reduces disputes later about what happened and when.

It also supports trust. Officers are more likely to report symptoms when they know the response is predictable, private, and not career-ending. For agencies trying to improve reporting culture, pair supervisor protocols with this guide on why officers fear reporting head injuries.

Implementation: train once, drill quarterly

Rollout is straightforward: publish a one-page checklist, train all front-line supervisors, run scenario drills quarterly, and audit compliance through incident reviews. Use near-miss debriefs to improve wording and thresholds. Agencies that treat concussion response as a practiced command skill, not optional wellness guidance, see better documentation, faster referrals, and safer returns to duty.