Safety concerns rise following cerebral injury related deaths

In light of the recent deaths of three high school football players in New York, Alabama and North Carolina due to traumatic brain injuries within the space of one week, a spotlight has been placed on the prevalence and dangers of concussions in high school athletics.

According to the Center for Disease Control (CDC), there has been a 60 percent increase in visits to the emergency department among adolescents with athletic and recreational traumatic brain injuries in the last decade. This increase in brain injuries reflects what many experts are calling the “concussion epidemic.”

The term “concussion epidemic” was initially coined in the National Football League (NFL) in reference to the steadily climbing rate of head injuries in the league over the past 50 years. However, this term has recently expanded to encompass collegiate and high school level sports as well.

Seeing over 12,000 patients with brain injuries within this year, Amy Knappen, Program Advisor to HeadFirst has experienced this increase firsthand. Although this number was higher than anticipated, Knappen said it may be a result of a boost in awareness about concussions and their symptoms as opposed to a surge of concussions themselves.

It is this education and recognition of symptoms that is most important in the diagnosis of concussions. According to the Sports Concussion Institute, fewer than 10 percent of concussions actually involved a loss of consciousness. The majority of concussions were less severe and were marked by headaches, sensitivity to light and noise and other less noticeable symptoms.

In most concussions, the biggest fear is Second Impact Syndrome (SIS), Knappen said. SIS occurs when someone suffers a second concussion before the symptoms of the first concussion have completely healed. The result is potentially lethal, rapid brain-swelling. According to the Southwest Athletic Trainers’ Association, 50 percent of SIS incidents result in death.

“Any child that dies of second impact syndrome is a death that was completely preventable,” Knappen said.

SIS can be prevented if an initial concussion is properly diagnosed and treated. The education on how this is done is very important, Knappen said.

Although many schools have athletic trainers to stand on the sidelines at sports games in order to monitor for potential concussion-causing injuries, this does not help with diagnosing concussions sustained outside of school, Knappen said.

In order to prevent SIS, Stevenson athletic trainers follow a very specific and detailed concussion protocol when Stevenson athletes suffer concussions, athletic trainer Nicole Stephens said.

At games, athletic trainers stand at the sidelines. If they see someone take a particularly hard hit, they do a mental and physical assesment of the student, as well as compile a detailed health history. Since symptoms are not always experienced immediately, trainers also check back in with the athlete the next day. However, if an athlete loses consciousness following the impact, they are sent immediately to the emergency room, Stephens said.

Stevenson has all of its athletes take impact testing. This is a computerized test that provides a baseline for students, Stephens said. If an athlete suffers a concussion, they take that test again to compare it to their baseline. Athletes cannot return to play until they meet their baseline and are cleared by an athletic trainer.

“Until you are completely symptom free, you must remain activity free,” Stephens said.

Upon return to physical activity, athletes are required to follow a five-day return to play protocol, Stephens said. On the first day, athletes can only do cardiovascular activity; on the second day, they can do cardiovascular activity and light sports specific activities; on the third day, they can do 50 percent of practice with no contact; on the fourth day, they can have controlled contact. On the fifth day, athletes can return to full practice. After this practice they can resume playing in games.

Allie Klein ’17 suffered a severe concussion that sent her to the hospital last February. She went through this entire concussion protocol. Klein said that although at times it was frustrating to be missing out on her sport, basketball, ultimately she thought Stevenson handled her concussion very well.

The trainers worked with Klein’s teachers to ensure her concussion did not affect her grades. Klein also said that her injury has not changed the way she plays.

“I have to be careful, but I can’t be afraid to do things,” Klein said. “I can’t be reckless.”

Another way to prevent SIS is to educate the general public about it. HeadFirst is one program that is working to provide this necessary education outside of the school environment. It is a community model for the diagnosis, management and treatment of traumatic brain injuries caused by a bump, blow or jolt to the head. HeadFirst usually has six to eight weekly speaking engagements where advisors like Knappen speak to parents, coaches, educators, nurses and athletes about proper treatment of concussions.

At these meetings, Knappen sees firsthand the lack of knowledge surrounding concussions. Many people at the meetings do not initially know what the symptoms of a concussion are, Knappen said. It is not until after they are told what a concussion entails that they realize they or their children may have suffered a concussion.

Another program that is taking steps to increase the knowledge and awareness of concussions is the Halton Student Concussion Education Program (HSCEP) in the Halton School District in Toronto, Canada. This course is considered to be the first of its kind to be taught across an entire school district in both Canada and the United States of America.

“The ultimate goal of the program is to empower students by helping them build the skills necessary to advocate for their own safety and the safety of others in their physical activities inside and outside of school,” said Rebecca Richardson, Instructional Program Lead HPE K-12 on the Halton District School Board.

Considering that one in five of all high school athletes will sustain a sports concussion during their sports season, it is increasingly important to know how to respond and treat these brain injuries effectively in order to minimize future risks. This education is vital is vital in allowing parents and students alike to recognize the risks of concussions, Knappen said.