Concussions: facts, resources, & MHS protocol

According to Phil Genatossio, the trainer for Milton High School sports teams, a student’s head is like an apple. This came up during a discussion about sports injuries in general and concussions specifically. He explains.

When an apple falls off a table, you pick it up. Look at it. It looks fine. But wait a day or two and a bruise begins to form. It is the same with a concussion. The effects of a concussion, which can result from any violent movement of the head, may take time to develop. This is why the MIAA is strictly enforcing a law which requires any student suspected of a head trauma be removed from the field of play and not return until cleared by a medical authority (view the rule here).

By way of quick background, here are some facts and data points:

  • As of October 29th all coaches in Massachusetts are required by the MIAA to take an online concussion course (find info and take the test here.)
  • Any player suspected of having a concussion is prohibited by MIAA rules of returning to the field of play during the same game and cannot return to play until cleared by a health professional.
  • Each year, U.S. emergency departments treat an estimated 135,000 sports- and recreation-related TBIs, including concussions, among children ages 5 to 18.(MMWR July 2007)
  • Weight is a critical factor in game safety. So much so that a few weeks ago, a private school in Newport, R.I., St. George’s, declined to play against Lawrence Academy of Groton, which had much bigger and better-skilled players. Lawrence has three linemen who weigh over 300 pounds. One weighs 350 lbs. This isn’t a college team. It’s a college prep school.

We met with Mr. Genatossio and Steve Traister, Athletic Director for Milton High School, because concussions are a hot topic in the news (a search of Google News for “high school sports concussions” returns 1,820 stories and that is only for the past week) and we wanted their perspective.

They shared the following.

First, the best way to prevent injuries is to be fit. There is a strong emphasis and focus on pre-season training. According to Genatossio, “You can’t play in this league if you do not prepare . . .  [we run] out of season weight training and stretch and flex programs.” This accounts for Wildcat football players having only 1 hamstring injury in five years. The other requisite keys to fitness are diet, nutrition, and hydration. The training program has been developed over the last six years. Six years ago there was no trainer. There was no weight room.

Second, the trainer is present on the field of play. He watches the game but not necessarily like a coach. He “knows where the play is going to go. ” What is happening downfield may not be as important to the trainer as what is happening back at the line of scrimmage.  Having a trainer present at games is one of the recent recommendations of The American Academy of Neurology. (Their position statement on sports concussions which they released last month can be found here. Their complete recommendations are below. The MIAA, and consequently Milton, regulations appear to align with them.)

Genatossio, who is also a certified EMT, believes that “you prepare for the worst everyday.” One of the tools used by the athletic department is the ImPACT test.  Through  generous grant from the Monack family, the athletic department acquired the equipment to administer the ImPACT test. This test establishes a baseline of neurocognitive ability. Should an athlete experience a head injury, the are given this test and the results are compared against the original baseline results for that athlete. Should an athlete be injured s/he does not get back unto the field of play unless cleared by a physician. Genatossio is adamant, “Parents can’t waive the right. The doctor makes the final say ok to come back.”

They noted that all trainers in the league get along well and share knowledge among themselves.

Traister and Genatossio believe they have the process and procedures in place. The issue is maintaining them. “We don’t make up the rules – we enforce them. They [school administration] don’t want us running a slipshod program.”

Recommendations of American Academy of Neurology

  1. Any athlete who is suspected to have suffered a concussion should be removed from participation until he or she is evaluated by a physician with training in the evaluation and management of sports concussions
  2. No athlete should be allowed to participate in sports if he or she is still experiencing symptoms from a concussion.
  3. Following a concussion, a neurologist or physician with proper training should be consulted prior to clearing the athlete for return to participation.
  4. A certified athletic trainer should be present at all sporting events, including practices, where athletes are at risk for concussion.
  5. Education efforts should be maximized to improve the understanding of concussion by all athletes, parents, and coaches.

Related resources & articles

from MIAA – updated 11/03/2010

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