Concord-Carlisle High School takes concussions seriously

by Ginny Lamere

The law states that all coaches, trainers, parent volunteers helping with athletic activity, doctors and nurses that are employed at a school, student athletes in all public schools and any school subject to Massachusetts Interscholastic Athletic Association (MIAA) rules will go through an athletic head injury safety training program annually. The Concord-Carlisle Regional School Committee will review the school’s Interim Head Injury Management Policy, which they will vote on at their next meeting. The policy includes aspects of training, assessment, communication and when to schedule return to academics and athletics.

Training will include recognizing the symptoms of potentially catastrophic head injuries, concussions and injuries related to second impact syndrome. The law also prevents athletes from going back into a game if they have any symptoms of a concussion. In addition, all athletes have to provide information on any previous head injury history at the start of each season. (See also “How can injuries be minimized in youth sports?” October 1, 2010.)

The Concord-Carlisle High School (CCHS) policy is the culmination of several years of effort by Athletic Director Barry Haley, the CCHS nurses Chris DeBruzzi and Kate Maher and Clayton Abrams who is a certified and licensed athletic trainer for CCHS. Maher explained that the school policy is more encompassing than the MIAA policy because it addresses all students with possible concussions, not just students injured in school or in the school athletic programs. Also, the policy applies to reentry into academic as well as athletic programs. Debruzzi said, “We have put together a strong head injury program. We’re working for the best outcome for our students.”

Growing data on concussions

“The majority of head injuries happen outside school activities,” said Haley, who was reached after the meeting. Head injuries from horseback riding, soccer and skate boarding make up a large part. He explained that concussions in soccer are from head to head contact, not from heading the ball. He emphasized that students with brain injuries need academic accommodations as well as a process for reentry into athletics. Haley and Debruzzi feel that the academic piece is extremely important. Students with these kinds of injuries are unable to handle six hours of classes. “They experience sensory overload which exacerbates symptoms of the injury,” said Haley.

When asked how many concussions he has seen, Haley replied, “We began record keeping according to the law this fall. There were 22 athletic [program]concussions; many others not associated with athletics were dealt with through the school nurses office.” Debruzzi said there were 17 brain injuries outside the CCHS athletic program. Most were from club sports, specifically football, soccer and volleyball. Others were from general falls or falls from horseback riding. When asked if this is a greater number than in previous years, Haley replied, “Due to the increased awareness of the dangers of head injuries I would say yes – but that is directly related to the global discussions of the dangers of repeat head injuries.”

Concussion policy

The policy states that any student who might have a concussion will be assessed by either the school nurse or the athletic trainer. Either may refer the student to a physician. Parents will be informed. If the student sees a physician, a note from the physician will be needed by the school nurse. The athletic trainer will follow up on the student if he/she was hurt during a school sport activity. If a student is experiencing symptoms of a concussion during school, he/she will be assessed by the school nurse. The administration, athletic director, teachers, guidance counselors and parents will be informed of the injury and a graduated academic and athletic return plan. The plan is facilitated and monitored by the academic team and the athletic trainer.

A student with a concussion will have scheduled follow-up assessments by the athletic trainer if the student is on a CCHS team or by the nurse if not. The policy states, “Only the following individuals may authorize a student to return to play: a duly licensed physician, a duly licensed certified athletic trainer, nurse practitioner, physician assistant or neuropsychologist, each of whom is working in consultation with a licensed physician. Documented medical clearance must be submitted and reviewed by the athletic trainer or school nurse as appropriate before the Gradual Return to Play procedure is initiated.”

Every student with a concussion will follow a written Gradual Return to Academics and Athletics with responsibilities of parents, students and school staff outlined. Medical documentation is required for a student to have academic accommodations. The plan is monitored by various school staff members in consultation with the physician involved. Debruzzi said an important part of the policy is communication with parents.

Symptoms may be subtle

Debruzzi said the number one physical symptom is headaches. But there are cognitive and emotional symptoms as well. Students may have trouble concentrating or remembering. They may experience sadness or increased irritability. Sleep patterns may also be disturbed with students sleeping more or less than usual or having trouble getting to sleep. She pointed out the student looks fine but the brain is injured.

It is recommended that student athletes take a 25-minute online neuro-cognitive test. This test provides baseline data that can later be used in post-injury assessment. The Athletic Department received a $4,000 grant from the CCHS Parents Association for the test. Maher administers the test. Haley commented that luckily, the school has a computer lab so 30 kids can take the test at the same time. Since this is the first year that students were able to take the test, Haley said some 450 students took it in the fall. Roughly 300 took the test for the winter sports season. He sees this number declining. In subsequent autumns, freshmen will be the majority of the test takers. The test is not mandatory. Parents can have their child opt out of the test.

Documentation for all the required training from all these people is also required. History of concussions must also be submitted. Haley is frustrated with the great amount of paperwork. “Each season the total is about 2,500 different pieces of paper, none of which does much to make athletics safer.”

Policy development

Haley said he had spent much of the last two and a half years working on the new policy, particularly since he was the MIAA President for some of that time. He said the state passed a law in July 2010 which did not define the rules or regulations schools are supposed to follow. The state never spoke to schools or the MIAA before passing the legislation, which has led to much frustration. He pointed out that the regional school district has been concerned about head injuries for a number of years and has raised awareness about the issue. For example, in the fall of 2007 and again in 2010, Dr. Robert Cantu, chairman of the Department of Surgery, chief of neurosurgery and director of sports medicine at Emerson Hospital, spoke at the high school on the topic.

When asked if particular sports have changed due to this law, Haley said, “We have for many years been more aware of the dangers so I don’t think we do anything different . . . We began baseline testing of all athletes this year which gives us another tool to determine safe return to play.”

Haley highly praised the CCHS nurses and athletic trainer for working together to develop the policy and fine tune it after the fall sports season. He has shared the policy with other school systems. His goal is clear: he wants a safe athletic program for the students. ∆