New law targets brain injuries in high school sports

December 3, 2012

By Joy Hepp
California Health Report

Like many of his contemporaries in cash-strapped schools across Southern California, Paul Knox is more than just a football coach at Susan Miller Dorsey High School. He’s a counselor, an equipment manager and a mentor who has sent more than 100 of his athletes to college on earned athletic scholarships. On weekday afternoons in Baldwin Village he’s also a watchdog against brain injuries.

“It falls upon us coaches to be vigilant about what we’re looking at and what we’re looking for,” he says. “We try and make sure we err on the side of caution, if there’s any question we’ll have the player have a medical consultation.”

Many school districts across the state have long required high school coaching staffs to be educated about the dangers of concussions and brain injuries, but this August Governor Jerry Brown signed a law that requires all high school coaches to complete concussion awareness training every two years. The on-line class is hosted on the California Interscholastic Federation (CIF) web site and was produced by the National Federation of State High School Associations and the Centers for Disease Control and Prevention.

Although brain injuries can occur in any high school sport, football players have the highest rate of injury (boy’s ice hockey, girl’s lacrosse, girl’s soccer and boy’s lacrosse round out the top five). According to a 2011 study by Purdue University’s Weldon School of Biomedical Engineering, of 1 million young men who play football each year nationally, “approximately 67,000 are clinically-diagnosed with a concussion, and it’s estimated that a similar number of concussed players remain undiagnosed.”

“Unfortunately not all schools have a certified athletic trainer to assist them in these types of injury evaluations,” says Mike West, President of California Athletic Trainers Association.

In fact, according to the CIF, only 19 percent of schools across the state employ athletic trainers on a full or part-time basis. “Those schools that don’t, they’re going to rely on coach’s awareness to say you know what, this kid is suffering from something serious as opposed to something that used to be considered getting their bell rung,” West says.

Nationwide, the average salary for a certified athletic trainer is $52, 935. For schools like Dorsey that rely on grassroots fundraising efforts like car washes and newspaper delivery to raise the $15-20,000 it costs to play a single season of football, having a medical professional on the sidelines at all times is simply out of reach.

“Absolutely we’d like somebody here every practice,” says Knox, who, like many coaches in the Los Angeles Unified School District, gets paid a yearly coaching stipend of $2800. “We could really use somebody out here to take care of those folks but if we could afford it, we’d actually have it.”

While schools in CIF’s Southern Section are required to have a physician or paramedic on hand during every varsity football game, schools are on their own during practice. The Dorsey Dons play home their games at the newly refurbished Jackie Robinson Stadium, but their practice field has seen better days. A lone set of bleachers is concave in a spot that looks like a linebacker used it for a hitting drill and players kick up dust on patches where grass refuses to grow.

“Because we don’t have medical supervision, practice is a situation where we have to really as coaches monitor as closely as we can,” Knox says. “If we have any doubt about a head injury, if it looks like a concussion we consider it a concussion.”

In the absence of full-time medical staff, experts hope that specialized training will help coaches like Knox protect their athletes.

“Hopefully it’s going make them aware of the potential consequences of if something is not identified, what could happen to an athlete,” West says. “And it at least will, for lack of a better term, scare them into if there is the possibility of a concussion that they err on the side of allowing them to go back in.”

Indeed, the training video and quiz contains simple, yet vivid language and imagery. Under a section titled “What is a concussion” one bullet point reads, “Brain bounces around or twists within the skull” and a subsequent animation shows a brain rattling around the inside of a downed soccer player’s cranium.

“The responses we’ve been seeing are really quite positive,” says Dr. Mark Ashley, Board Chairman of the advocacy group, Brain Injury Association of California. “There’s a degree of relief in having training available. There’s probably a minority [of coaches] that say this is going to impact my ability to field my team, but that’s a pretty short-sited and inappropriate mindset.”

Even when schools can afford extensive medical supervision, brain injury threats and consequences are never far from the field. Notre Dame Catholic High School is a Catholic co-ed college prep school in Encino that employs two athletic trainers and is home to a robust sports medicine educational program.
During their October Homecoming game against Loyola High School, the Irish Knights are also being monitored by Dr. Andrew Blecher, a sports medicine expert who he sees 3-4 concussion patients a day at his practice in Van Nuys during football season.

Although there are no concussion scares on the way to Notre Dame’s victory, Dr. Blecher still has work to do. He keeps a close eye on tackles when players lead with their helmets instead of their bodies and consults with a student who missed two weeks of school after sustaining a concussion.

During halftime, while this year’s homecoming queen is crowned in front of a Candy Land-themed backdrop and fireworks splash across the San Fernando Valley sky, Dr. Blecher visits a player in the locker room who had suffered a concussion on the field two weeks prior. The player had been sitting out the game and attempting watch the action with his classmates in the bleachers, but the festivities proved to be too much for him.

“Kids get very sensitive. Bright lights, loud noises, excitement – they all make symptoms worse,” Dr. Blecher says. “The Homecoming dance is tomorrow and he can’t go. It really affects their entire life.”

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