by Dr. Eugene Bailey MD
Concussion Assessment in the Past
Since I have been with East Syracuse-Minoa (ESM) High School starting in 1994, concussion recognition has taken an earnest turn in the right direction. Before 2011, when ESM decided to establish a protocol for diagnosing concussion field-side, most head injuries were labeled as “bell-ringers, ” and athletes would return to play without a formal, standardized assessment of the trauma.
It is hard in the heat of competition and with an important game on the line to remove your star player from the team – after all, the team depends on this person and playoffs are looming in a few weeks. Coach is asking, “can he play?” We would quickly assess the quarterback by asking him some questions about a headache and determined that he could return to the field. We never formally performed rigorous testing addressing his symptoms, cognitive impairment or balance abilities. Thankfully, there were no further incidents and the game finished without further injury.
Never Sure If We Got it Right
As I reflect back on this, it strikes fear in me that I could have put that kid out on the field at risk of further injury because he may not have been 100%. He may have lied to me about his symptoms and felt the pressure to return to the field for his parents, for the coach, and for his teammates. Further, I subjected this player to possible double-impact or even long-term cognitive impairment. We did not have any protocol or impetus to follow until recently because concussions are in the headlines.
New Strategy – New Protocol
For the past four years, we have implemented a concussion protocol for all high school sports at ESM. It is a paper-based system, and although it helps field-side, we have no way of tracking these kids once they return-to-play. The paper system is cumbersome and does not use some crucial cognitive and balance issues associated with an accurate concussion assessment. We developed this internal to our high school as well. When playing other teams, it is not apparent what system they use for concussion assessment.
Key Improvements Implemented
What we have learned since implementing our concussion recognition protocol has been invaluable to our school, coaches, and players. We believe our kids are safer with the new protocol, but there is room for improvement and room for change. Some key elements include the following:
- Athletic Trainer(AT) – It is of particular importance that every high school who wishes to have competitive sports hire a certified athletic trainer. Any professional or other competitive organized sport that recognizes the safety and performance of its athletes knows that this is vital to their organization’s success. The AT is critical to not only concussion recognition but also the other aspects of assessment and management that goes well beyond recognition during play. They are a vital link between player, doctor, and coach.
- Concussion Assessment Protocol- Having an easy-to-use concussion recognition protocol at field-side so that an accurate, reproducible and fairly thorough assessment can be done to recognize any concussion, even if considered mild. This protocol should be accessible to doctors, ATs, and coaches. It should also be consistent throughout all schools so that everyone is on the same page. It should also be placing data into a database for further use and permanent storage.
- Emergency Response – The protocol at field-side must allow for emergencies and have a set assessment for the recognition of a player who needs immediate attention and transfer to hospital by ambulance. If a situation presents itself as life-threatening, then any delay in recognition and treatment could be catastrophic.
- Communication – Once the concussion is recognized it is important to communicate parameters among all parties involved. Stakeholders include parents, coaches, physicians and the athletic trainers. Having a shared database for all to access that is HIPPA compliant is important to be sure that all medical personnel and school staff can track the concussed student. Communication is essential for the return to play as well as learning activities in school.
Computer Based Mobile / Phone Application
We at ESM have determined that we can do better. Three core members of the school staff, including two physicians and the athletic trainer, recognized that we needed a better way to recognize concussion field-side. It needed to be quick, efficient, evidence-based, and create a record of the injury. Also, we want it to be the same or at least very similar to the opposing team’s concussion recognition guidance.
In response to this need, we formed a team to develop a mobile /phone application (Phone App.) and overall management scheme to improve the accuracy and consistency of recognizing a concussion. In reviewing the above key elements, it can address several of them.
- Athletic Trainer(AT) – Although an AT is so critical to the success of any sports program, many schools cannot afford to pay for one – this leaves a significant gap in their sports programs. This application can help coaches and other faculty recognize a concussion and improve concussion management.
- Concussion Assessment Protocol- This application is developed from the Zurich Concussion Consensus guideline that meets annually to review the recognition, assessment, and management of concussion. It endeavors to provide the most up-to-date information available to all high schools that purchase the app.
- Emergency Response- According to the guidelines there are specific features to a head injury that warrants immediate evacuation and the field-side application will make these easily accessed and can be performed on all athletes suspected of concussion
- Communication – the application will store all data in a searchable and online database that is accessible to participating schools and physicians who have the app. The database allows for seamless transferring of data and tracking the athlete through the concussion process until cleared for return to play. It can also be accessed by parents and other schools as well.
Let’s Do More to Keep Them Safe
Concussion recognition is the beginning of a thorough, evidenced-linked and safe return for our high school athletes. The best and most consistent way to perform this is currently elusive but much work and effort is being placed in this area. It is vital that we do more for our HS athletes so that we keep them safe during their sports careers and also ensure their futures in this area.
If you would like more information
Please feel free to contact Dr. Baliey (Gene) via email Doctors@easySCAT.com