One of the most important steps that a school or independent sports program can take to ensure that athletes playing contact (e.g. football, lacrosse, hockey) and collision sports (e.g. soccer, basketball) who suffer concussions playing sports have the best possible outcome in both the short- and long-term is to hold a concussion safety meeting before every sports season.
While every state in the country now requires that parents and players (at least at the high school level) receive some basic concussion safety information as a condition to participation, more education than can fit onto an 8 1/2 by 11 sheet of paper is urgently needed.
Ideally, the meeting should include presentations by:
- The coach. The coach should be front and center at any concussion awareness meeting in order to:
- Actively, consistently and repeatedly encourage honest self-reporting by athletes of post-concussion signs and symptoms, both their own and those of their teammates (such as by employing the same kind of buddy system football programs often employ to protect athletes from heat illness during hot weather practices and games, and which MomsTEAM featured in its PBS documentary, The Smartest Team: Making High School Football Safer);
- Reassure athletes that they will not jeopardize their position as a starter or place on the team if they self-report, that he will not question their toughness, call them "wimps" or "sissies," or ostracize them;
- Inform players that deliberate hits to another player's head will subject them to disciplinary action; and
- Advise athletes that they will be considered in violation of team rules, subjecting them to possible discipline from game suspensions up to and including disqualification for the season if found to have impeded appropriate evaluation and management of his own concussion by failing to report or under-report symptoms (theirs or a fellow player's); intentionally underperforming on baseline neuropsychological tests in order to maximize chances of being cleared to play even with symptoms; or indicating they are symptom-free so that they can be cleared to play in the next game when they are still experiencing symptoms.
- Medical doctors familiar with the identification and evaluation of concussions and return to play guidelines to educate parents on the important role they play, both in identifying and in their child's recovery from a suspected concussion, especially in terms of:
- checking for signs of deteriorating mental status requiring immediate hospitalization,
- ensuring that their child gets the cognitive and physical rest required,
- monitoring for continuing or delayed onset of concussion signs and symptoms, which must clear completely before an athlete should be allowed to even begin the gradual return to play protocol, and
- educating their child about the short- and long-term consequences of a failure by the athlete to honestly report symptoms, of continuing to play while experiencing symptoms, or of returning to play before symptoms have
cleared and cognitive function (memory, reaction speed, etc.) has returned to pre-concussion baseline levels, including
- a prolonged period of recovery
- increased likelihood of a second concussion
- increased likelihood of long-term cognitive, emotional, and psychological problems, and
- in very rare cases, death from Second Impact Syndrome.
- Former athletes who can share personal stories about the consequences of continuing to play with concussion symptoms and/or the long term health consequences of multiple concussions, such as reoccurring headaches, depression, and concentration and memory problems (or, in lieu of former athletes, real case studies illustrating the damage concussions can cause in the absence of early identification and conservative management)(1). A 2013 study reporting on the "overwhelming" problem of underreporting of concussion (2) recommends that improved concussion education should include providing "platforms for individuals, especially those respected in the athletic community, to speak out about concussions and why these injuries should be reported and managed properly."; and
- Parents of concussed athletes who can emphasize how critical it is that, in making the all-important return-to-play decision, parents, coaches, and health care professionals put a child's long term future and well-being above short-term athletic success; that parents constantly evaluate, along with their child if she is old enough, whether the risk of chronic, major depression or early signs of Alzheimer's down the road may make ending a career the best choice.
An attitude adjustment of coaches in contact and collision sports is critical if the culture of such sports is to be changed. Resistance to change to improve concussion education and care from those concerned more about winning than about the safety of children is to be expected, but parents and every other stakeholder in youth sports owe our kids nothing less.
Regardless of whom the program calls to make presentations at the meeting, the goal should always be to encourage honest reporting of possible concussive events by providing a "'safe' reporting environment" (2) and provide parents and athletes with the information they need to decide when it is safe to return to play, whether it be the next game, next season or not at all.
To reinforce the message of the meeting, parents should be furnished with information to take home, such as articles from the MomsTEAM concussion center, or obtained from the Center for Disease Control (CDC) as part of its "Heads Up" kit.
Parents are in the best position to help their child see that their health should not take a back seat to short-term individual and team success, but they need to know, also, that the program is not sending out a different message.
Updated November 10, 2015
1. Echlin PS, Editorial. A prospective study of physician-observed concussion during a varsity university ice hockey season. Part 1 of 4. Neurosurg Focus 2012;33(6):E1 (published online ahead of print)(accessed December 10, 2012).
2. Register-Mihalik JK, Guskiewicz KM, Valovich McLeod TC, Linnan LA, Meuller FO, Marshall SW. Knowledge, Attitude, and Concussion-Reporting Behaviors Among High School Athletes: A Preliminary Study. J Ath Tr. 2013;48(3):000-000. DOI:10.4085/1062-6050-48.3.20 (published online ahead of print)