by Alissa Krivashei
September 16, 2010 was a beautiful day, full of the heat of summer, the smell of cut grass and the unmistakable stench of high school football. The ambulance arrived only a few minutes after my son, Chase, started showing signs of confusion on the sidelines. Some said that they thought he had a seizure. No one had seen what had happened to him. A friend of mine, who is an EMT, told me that the trainers suspected that Chase had a concussion. The good news was that he remembered his name and how to count, but he did not know where he was or that he had even been playing football.
This was Chase’s first concussion, so I was unsure of what the protocol was. No sooner had I settled down, when I heard sirens. I turned to my friend and yelled, “You said everything was ok!” He assured me that this was just procedural. Every parent, my friends and my family held a collective breath as Chase was strapped to the gurney and loaded into the ambulance. The players on both sides of the field were more than a little timid getting back into the game.
The idea that a kid could be injured in a game was more than anyone wanted to comprehend. Little did the players know how much the next few weeks would challenge Chase. Most players who suffer a concussion are only out for a week, but that wouldn’t be the case for him. Chase would struggle with pain, frustration and a fear that returning to the game could change his life forever.
With an estimated 62,000 football related concussions each year in high school alone, traumatic brain injuries have become a main concern for officials, coaches, players and parents alike. Since I started my research three weeks ago, 2 football players in Riverside County have suffered severe, career ending concussions. One of these boys was airlifted off the field and is still on life support as of September 26, 2012
As more information becomes available about how the injury can affect the victim at the onset and in the long-term , professional football, college football and high school football programs are beginning to look at the impact of these injuries and the future of how the game can be played safely. As of May of 2011, 17 states have passed their own concussion laws that promote the development of an athletic concussion safety program and concussion safety requirements. As of today the number of states that have adopted concussion laws has doubled.
California is one state with laws requiring school districts to implement a concussion and head injury protocol. Centennial High School (CHS), Chase’s school, is one that goes above and beyond the minimum state requirements. Bill Pollock, P.A. (Dr. Bill), the team doctor for CHS, presented his argument for purchasing a concussion testing system in early 2010 to use for assessing baseline brain function for the football teams of the district. This new system is a computer based testing system that stores results from the original test that can be used to confirm the possible severity of a concussion. The Corona-Norco School District held out on purchasing the new system until 2011, making the treatment of Chase’s concussion like trying to find the proverbial needle in the haystack.
The testing protocol used on Chase consisted of doctor visits once a week during which he would take balance tests, memory tests and general orientation. The big indicator for returning to play was a consistent absence of headache. Without a baseline for Chase, Dr Bill needed to take a slow and steady route in determining injury status and so the first step was to see when the headache would cease. Dr Bill instructed us that Chase was not to go to school, not to watch television, not to listen to music and to rest in darker rooms that were cool.
I just thought that he needed to take it easy, it never occurred to me that all of the listed actions required use of his brain. Once his headache stopped, we could start adding activities one at a time in a 24 hour period, checking to see if any brought back a headache. If he did not get a headache, then he could move to the next activity; if the headache returned, he waited until the headache stopped, then 24 hours later, tried the activity again.
This process took a full six weeks before Chase could return to football. Most football players who are diagnosed with a concussion, unless noticeably severe, return within one week. Here is the upsetting piece of information: Chase’s concussion was not noticeably severe.
The question then becomes, why did it take so long for Chase to get back i
n the game? Simple. He had a good doctor who had been doing a lot of research about concussions. His doctor understood how important it is to follow a protocol in order to protect Chase from any long-term damage.
I spoke with Danna Dye, Centennial’s certified team trainer on September 14, 2012, right before game time and she stated, “It is not really about the first hit, it is about the second hit and preventing second impact syndrome.” Second impact syndrome (SIS) is a second concussion that occurs before the original injury has completely healed. SIS is considered rare and hopefully that is because someone who has suffered a concussion is out of the game. It is important that concussions be treated properly because the problem with second impact syndrome is that is can lead to death.
The California Interscholastic Federation (CIF) has placed importance on the treatment of concussions by enacting a new rule that took effect this season. Bylaw 313 states, “A student-athlete who is suspected of sustaining a concussion or head injury in a practice or game shall be removed from competition at that time for the remainder of the day. A student-athlete who has been removed from play may not return to play until the athlete is evaluated by a licensed health care provider trained in the evaluation and management of concussion and receives written clearance to return to play from that health care provider.”
This new rule should help the trainers and team doctors treat a head injury properly. But even with the CIF’s mandate, there are still teams out there who are putting student athletes in danger by letting or forcing them to play with a concussion.
On September 7, 2012, at a Centennial High School home game, a couple of kids on the visiting team suffered mild concussions. The team only had student trainers on the sidelines but no certified trainer with them. One of the players told the coach that his head hurt and he couldn’t continue to play. The coach ignored his statement and forced him back into the game.
Concerned, the student trainers approached Danna Dye at half-time to ask for her guidance. Dye took control and asked the student trainers for the emergency cards that are supposed to be on the field, with the team at all times. They told her that they did not have the cards, but that luckily the athlete’s parents were in the stands. It is fortunate that the student trainers had the foresight to ask Dye for assistance, otherwise, we might have witnessed a SIS in our own stadium.
This is a prime example of the continuing problem with concussion diagnoses and enforcement of not only the rules laid out by the CIF, but also common sense. Every day there is a new report of an athlete suffering a concussion ranging from mild to severe and occasionally, even death. It is vital to adhere to the new protocols and for each high school to be prepared for any emergency that might come their way.
There are new technologies available to assist in diagnosing and detecting head trauma. The NFL has been funding independent medical research in many areas, from ankle sprains to heart health, but none are more important than the study of concussion and neuro-degenerative disease. The concussion research has been done in conjunction with Virginia Tech University and the University of North Carolina. North Carolina has been testing a new sensor system (HITS – Head Impact Telemetry System) that is placed in the helmet. The helmet records all of the impacts and then following a game or practice that helmet can be analyzed by a computer program. The helmet and computer program are quite expensive, $999 for the helmet and $309.99 for the computer program sold by Riddell helmets.
The benefit of the HITS system is yet to be seen as the data is presented when the player presents his helmet for evaluation after practice or a game. Riddell is currently testing a new system to work in tandem with HITS called SRS or Sideline Response System. The SRS will record real time data and can notify the sideline medical staff if there is a player who has had a significant impact on their helmet. This allows the medical team to assess the problem right when it happens and determine if someone has suffered a concussion.
The SRS is not ready to be used at all levels, but Riddell is anticipating release for the 2013 football season. With no indication from Riddell of the projected cost of the new system, it is uncertain whether high school or college teams will be able to invest in this new technology, but the NFL has the means.
The game of football will undoubtedly change as an estimated 140 concussion lawsuits have been filed by former players of the NFL. This action alone will help to bring the seriousness of concussions and concussion awareness and its importance to the public.
Centennial High School and the Corona-Norco School District have taken the first steps by not only setting up a protocol, but purchasing a testing program to help insure an extra measure of safety. The varsity football coach at CHS, Coach Logan told me that he takes himself “out of the game” when the words “concussion” or “traumatic brain injury” are mentioned.
“I defer all of the judgement of when to return to the game to our training staff. Danna Dye is very conservative with her diagnosis and works with medical staff in order to protect our athletes from further injury,” he said.
Coach Logan’s concern for his players is admirable, and it is unfortunate that concussion protocols and player safety have not become the priority of every football team from peewee football to the pros. Yes it is true that the experts are still trying to understand the long term effects of concussions, but taking a life or death chance instead of erring on the side of caution is just plain silly. The good news is that even if the administrations of the different football organizations are not taking it seriously, some players are and that is evidenced by the number of them who are taking themselves out of the game and even some that are walking away for good.