S tudent athletes who suffer a blow to the head will no longer be allowed to “play through” the injury according to new concussion management guidelines that took effect earlier this month.
The nearly 30-page document released by last month by the New York State Education Department and developed by an advisory group consisting of doctors and state education officials establishes a more stringent procedure for allowing a student to return to play after suffering a head injury. The guidelines in the document were developed in response to legislation signed by Gov. Andrew Cuomo last September.
“It takes the responsibility away from the coaches and leaves the decision up to a medical professional. It ensures everyone is following the same guidelines,” said Keith Redmond, athletic director at Whitehall High School.
Mike Macura, who recently retired as athletic director at Granville, said education is a critical part of the process, for all parties. It’s important for coaches to recognize symptoms, for players to understand the risks of repeated concussions, and for parents to realize “getting your bell rung” can be serious.
“Concussions can happen anytime. It’s not just games, it’s practice too, which is why it’s imperative that the coaching staff is well-trained in concussion management,” Macura said.
The new guidelines are a result of the Concussion Management and Awareness Act that went into effect on July 1 and are aimed at educating students, parents and school district personnel on concussion management in schools.
Under the law, any student who suffers, or is suspected of suffering, a concussion, must be removed from athletic activity immediately.
If it is the student’s first known concussion they cannot return until they have been symptom-free for a period of 24 hours and been cleared by a doctor. If the student suffers a second concussion they must be symptom free for seven to 10 days and have clearance from a doctor.
The concussion act also recommends that schools follow a five-day process for returning students to full sports activity called the Zurich Progressive Exertion Protocol.
Once a student has been cleared by the doctor, it is suggested they begin a graduated return to activities.
The first day would include 30 to 60 minutes of light walking. If symptoms don’t return they would move on to the second day, or phase two, which may include 10 to 15 minutes of light walking.
Phase three would involve more aerobics and increased exertion beyond phase two. The fourth day would include a return to practice and non-contact drills. The final phase is a full resumption of activities and if there are no issues, athletes may are cleared to participate without restriction.
If symptoms return at any point, students should drop back down to the previous level of activity.
Although the process is recommended and not required, officials at Whitehall said it’s something they plan on implementing and Granville has something similar in place already.
By the numbers
The Centers for Disease Control and Prevention estimate that 1.2 million people suffer a concussion each year.
A concussion is a form of traumatic brain injury that is caused by any action that jars or shakes the brain inside the skull. In some cases it can result in a brief loss of consciousness, temporary amnesia, or a feeling of confusion. Symptoms don’t always appear, however, and some people may not even realize they suffered the injury.
Many times, concussions can be treated with acetaminophen and rest, but repeat concussions can be dangerous.
If a person suffers a second concussion before recovering from the first, the brain can be damaged permanently. In rare cases, the brain can swell causing the person to die.
Some studies have also shown that people who have had multiple concussions during their lives are at greater risk of developing Alzheimer’s or depression.
The cumulative effects of concussions and the dangers they may pose are just starting to be understood, which is why education is a key component of the new legislation.
The law requires schools to provide information about concussions on parental permission slips and on their websites.
It also requires all coaches, physical education teachers, nurses and athletic trainers to receive instruction every two years in recognizing symptoms of mild traumatic brain injuries, something many local coaches and teachers have already been doing.
“We had all our coaches and physical education teachers take the course last year,” said Redmond.
Local coaches said they support the bill.
“I like this. I’m not normally in favor of government legislating sports at any level, but I think this is a good step,” said Justin Culligan, head football coach at Whitehall High School. “It’s good to take the decisions out of our (coaches) hands.”
Culligan said diagnosing a concussion can be challenging.
He discussed an incident last year in a game against Fort Edward in which a player passed a series of “checks” used to indicate whether someone has suffered a head injury, only to discover later that he had suffered a concussion.
“We can take concussion courses, but none of us are doctors,” Culligan said. “It’s good to take the decision out of our hands. Some coaches are ethical and some are not. And the kids are good at hiding these things because they know it means they won’t be able to play.”
Granville best practices
Mario Torres, head football coach at Granville High School, said many of the things included in the legislation are things the district has previously implemented.
“It’s (the law) isn’t much different than what we’ve already been doing.”
He said Granville has a doctor on the sideline of every home football game, something the district has been doing for years. The district also developed a concussion protocol last year that adheres to the requirements of the new law.
The protocol includes a concussion management team that will consist of the athletic director, school physician, school nurse, physical education teacher, and a parent and classroom representative.
Granville’s Macura said the team works well because the members can share observations to determine how a student is recovering from a head injury. For instance, if a student is having difficulty concentrating in the classroom, that’s a potential symptom that can be shared with a physician before a student is cleared to play.
Whitehall took steps to have trained medical personnel at football games last year, having at least one local EMT on the sideline each week and Redmond said they are looking into the possibility of having a doctor at each home game this year and possibly one or two student trainers from Castleton State College.
Both districts also have equipment inspected each year to ensure it’s compliant with safety regulations and in usable condition.
In the last few years Whitehall has also purchased protective head gear for the soccer team’s goalies, and Redmond is in the process of developing a districtwide concussion management plan which will be implemented later this summer before the fall sports season begins.
‘A great thing’
Both Torres and Culligan said they’ve had players suffer concussions — Whitehall had three confirmed concussions last fall and Granville held a few players who were held out for a week or two as a precaution — but have been fortunate to avoid any severe head injuries.
While the risk of concussions in sports can’t be eliminated, especially in a sport like football, the coaches said the injuries can be limited by ensuring protective equipment fits properly and teaching athletes to the correct way to make a tackle, instead of initiating contact head-first. And when they do happen, local school districts will be prepared.
“It’s (the law) definitely a great thing. It’s all about protecting the kids and making sure they can go on to do things beyond high school,” said Torres.