Concussion Conundrum

Seattle Children's Hospital provides education and best practices to both handle and prevent mild TBI

You can scarcely go a week these days in sports related radio and television, and definitely not in terms of programming centered upon football, and not hear the topic of concussions and head injuries brought up in some kind of discussion. Be it new potential legislation, garden variety injury updates, or a broader commentary on the preponderance of them in sports, mild Traumatic Brain Injuries (mTBIs) are a fixture in the news and the wider conversation of safety in athletics.

In spite of all the handwringing about rule changes or wrapping players in cotton, the simple truth is that injuries, especially those suffered to the cranium, are a potential occupational hazard of playing sports such as football or ice hockey. It's a known entity entering in, a double-edged sword which can be modified but not removed, lest the very spirit of these beloved games be stripped.

Still, even as completely stamping out these damages may prove impossible, there has likewise been a long history in the world of competitive sports of misdiagnoses and "toughing it out" at the expense of a head and brain which may have already absorbed considerable trauma. Fortunately, cooler (and better protected) heads have prevailed and there are now, across the United States, initiatives and even legal measures being taken to ensure the safest possible conditions. ADVANCE had the privilege of speaking with Philip Heywood, MS, ATC, AT/L, and Head of the Athletic Training Program at Seattle Children's Hospital, about his team's work in this endeavor and their involvement with the youth sports of the city and throughout Washington's King County working in concert with the hospital's Seattle Sports Concussion Program.

An Ounce of Prevention

Akin to being told to wash your hands or look both ways when crossing the street, preparative care couched within a proverbial "ounce of prevention" philosophy is seldom going to be the headline grabber. Heywood could not stress enough the importance of providing comprehensive information and education both on properly fitting equipment and practice modifications. Both of  these can reduce the chances of concussions and related injuries. He also stressed  n a better understanding of signs and symptoms of concussion should they arise.

"Prevention through education and empowerment is really the biggest and best thing we can do on behalf of these athletes as Athletic Trainers. Beyond teaching proper  techniques around tackling or heading the ball in soccer, it's very important that every athlete who plays high school or recreational  sports and their parents, for instance, understand possible symptoms so that they're able to get the care they need."

There is a (merited or not) perception of coaches in youth sports sometimes placing far too high a premium on winning at any cost, but when asked about this in terms of how receptive coaches have been to Heywood and his team's input, he pointed out the uniqueness and cooperation of Washington as a state thanks to the Zackary Lystedt Law, passed in 2009.

Lystedt's Impact

"The Zack Lystedt Law absolutely sets Washington apart in the United States and coaching communities across the state have done a great job in adopting it. It holds that coaches and any non-clinicians are no longer allowed to make any return to play decisions on behalf of the players, so you might say that  hands are being tied in a good way."

Insofar as the care provided by the athletic trainers on Heywood's staff, there are 18- soon to be 21 ATCS-working within various high schools within Seattle and King County. The athletic trainers almost always travel with their respective teams; if, however, they are unable to attend a game, coaches know to pull players from the game when it is apparent they've incurred some sort of injury to  the head.  So long as the athletic trainers are there, however, there is a standard set of procedures in place that help to ensure that those players are getting the care and attention they need.

"We treat players on the field using the SCAT3 (Sport Concussion Assessment Tool) evaluation form. On the field, our protocol is to assess for concussion, we do not diagnose. The process is to assess, remove from play, and refer to a licensed health care provider. Whether or not an athletic trainer is there, coaches have been educated on what to do in case they suspect a head injury. "

Lest anyone contemplate ideas of soldiering through headaches and dizziness in the pursuit of greater glory, Heywood dispelled that notion by stating that the Lystedt law is "clear" and that "an athlete must be further evaluated by a licensed healthcare provider  trained in the evaluation and  management of concussion." This is mandatory and it precludes students, parents, and schools from circumventing the spirit of the initiative by not following through with an appropriate provider.

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Working  the context of a school environment and within the framework of an overall program meant to avail kids and student athletes of quality care across several different medical disciplines, Heywood said that not only do athletic trainers stay in direct communication with those that they treat, from on-field assessment to their return to play discharge, but they also can work in a variety of ways to help make the recovery period smoother for student athletes in areas beyond the playing field.

On the Front Lines

"In being very involved and working hand-in-hand with the healthcare provider, we try to make sure that the athlete is making good decisions and that they and their parents have all the information at their disposal to do so. Having athletic trainers in a school setting, we focus on an idea of a return to learning, return to play, and return to life. In the same way a football coach might not fully grasp the ramifications of injuries, so to might school administrators. When working with these athletes off the field there will come a time when we have to tell them they might not be able to go back to school or there might be modifications in the way they learn at school for a while.  This can be very difficult for some to hear, and fully comprehend, but ultimately necessary for full recovery from an mTBI."

Above all else Heywood said that and his team of athletic trainers, empowered by strong legal language such as that found in the Zack Lystedt Law are able to stand at the "front line" of concussion assessment and management. 

"As athletic trainers, we  are on the front line and it is our responsibility to ensure that the athletes we oversee are cared for appropriately.  All too often we see athletes with head injuries that have not been managed properly, and have returned to school or their sport to soon.  This can be very dangerous and can have a lasting effect on these student athletes.  We need to make sure that best practices in concussion management are being done with the student athlete best interest in mind.

With a law that has some real teeth and a team of athletic trainers who have some real heart, student athletics in the state of Washington are making progress and moving ahead.

Tamer Abouras is an Editorial Intern at ADVANCE




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