If you recall Tom Hearn from Maryland had the opportunity to present information to the Maryland State Board of Education about concussions. What resulted was a discussion among the board, Hearn was able to get a transcript (link at end) of this discussion and we have highlighted some key points (they begin on page 5). The time marking represents where on the audio file you can find the information (working on a link for that)
Kate Walsh (MdSBE Board Member): I think the Board’s interest here was to get at testimony before the Board in public comment. I think these are all great things that you have done, but there were three complaints that were raised that we thought were quite compelling, and we wanted to hear them addressed. And I don’t hear you really addressing any of them.
So, can we go through this? What we heard was that there were regulations similar to those adopted by the Massachusetts Department of [Public] Health, have we done that? Have we adopted regulations that are similar to those?
Ned Sparks (MdSDE Athletics, Executive Director/MPSSAA Executive Director): No. Again, those were regulations of the Department of Health in Massachusetts.
Kate Walsh (MdSBE Board Member): So is that something you saying that we would not adopt be under another?
Ned Sparks (MdSDE Athletics, Executive Director/MPSSAA Executive Director): I don’t know the regulations exactly how they are in Massachusetts but I would think that that would certainly be a combination of the Department of Health and the Education Department regarding that. [It sounds like, since the Mass DPH regulations were brought to the attention of the State Board in the parent’s May 22, 2012 testimony—five weeks earlier, Mr. Sparks had not yet reviewed the regulations.] Now, again, we had a representative on that group as you can see from the Department of Health and Mental Hygiene, as a matter of fact two of them.
Renee Spence (Executive Director, MdSDE Office of Government Affairs): We work very closely with folks from the Department of Health and Mental Hygiene. Also, in Maryland, the Governor has put together a traumatic brain injury commission. There are a lot of folks working on traumatic brain injuries.
Kate Walsh (MdSBE Board Member): I just think it would be helpful if we could see why this Massachusetts Department of Public Health were cited as superior to our own and if we could do a comparison of the two. That would be really helpful.
And then, the second thing just seems sort of obvious, impose limits on full contact practices [in football]? Is that not something under consideration here? Why are we rejecting that?
Ned Sparks (MdSDE Athletics, Executive Director/MPSSAA Executive Director): We didn’t reject it. Right now there is no real data that would suggest that as far as the number of injuries.
Kate Walsh (MdSBE Board Member): Well the NFL has done it.
Ned Sparks (MdSDE Athletics, Executive Director/MPSSAA Executive Director): They have done it in that regard. But you know we are talking about, for example, I know, I read through a little bit of what the comments were regarding the Ivy League [Mr. Sparks appears to be referring to the parent’s May 22, 2012 testimony, which he appears to be saying that, five weeks later, he had only read “a little bit of.” ]. I think the Ivy League says two days of contact hitting in football during the week. Quite honestly, as a former football coach I don’t know if anybody would do more than two-a-days. You take your normal schedule and you play on . . .
Kate Walsh (MdSBE Board Member): So then why would we have a problem imposing that reg?
Ned Sparks (MdSDE Athletics, Executive Director/MPSSAA Executive Director): Well some people might play on Saturday and might need an extra day of practice. I don’t know if we want to get into that detail regarding . . .
Kate Walsh (MdSBE Board Member): I would like to. I mean, we are talking about kids’ health, I mean this guy had very compelling testimony about children and we all read about adults who are impacted by this constant exposure. I am just telling you as an uneducated person on this issue I think it is extremely compelling and the specifics are something that we should consider. I mean I am sure that you guys are trying to do your best with this issue, but I think we need to be a lot more educated as a board to decide what we aren’t doing compared to others.
Sayed Naved (MdSBE Board Member): You mentioned that you do not have data, where would you go to get the data?
Ned Sparks (MdSDE Athletics, Executive Director/MPSSAA Executive Director): There is a national group that is beginning to collect data on injuries. They are very very specific in that regard and these injuries might be, for example, did it happen in a game? Did it happen in practice? If it happened in a game, what part of the game? If it happened in practice, what part of the season, how early in practice? That information is being collected by a group out of Ohio State University and that information is shared across the country with the National Federation of local school and States Associations. So there is information coming out. The organization has been actively at it for about five years. We are beginning to start to get new good information. When do these injuries occur? How do they occur? At what time of the year do they occur? All of that information, I think is important information before we would move into banning certain things that might not necessarily . . .
Sayed Naved (MdSBE Board Member): Did the NFL not have data before . . .
Ned Sparks (MdSDE Athletics, Executive Director/MPSSAA Executive Director): I don’t know what the NFL uses. I know you are talking about a different category there. You are talking about adults as opposed to adolescents and certainly there is a difference there and we certainly recognize that.
Kate Walsh (MdSBE Board Member): Isn’t the brain of a child even more sensitive than an adult?
Ned Sparks (MdSDE Athletics, Executive Director/MPSSAA Executive Director): I think so but I am not a doctor.
James DeGraffenreidt (MdSBE Board Member, President): Let me just try to weigh in here. I think there are two things going on here. First of all, my understanding what the NLF did was part of their latest player negotiations so whether they had data or not I don’t know but I know this is a negotiated deal with the owners of the teams. But that is sort of beside the point.
I think what is behind Ms. Walsh’s comments is, an understanding that I think we are going to need to have, and that is, the Board needs to understand what is it that we should be doing around this issue. We need to understand what the Health Department, Health and Hygiene, is doing. Just so we know that the issue is covered.
If it is not something that we ought to be developing regulations about that’s fine, but we need to understand that somebody is. We don’t want it to be a slip-through-the-cracks kind of an issue. Because not only is it an issue that has gotten a lot of national prominence, it is a serious youth sports-related health issue and it is our responsibility when something is brought to our attention to understand what it is and what our responsibilities are and what is going on out there and how we can make the situation better.
Donna Hill Staton (MdSBE Board Member): And I didn’t know we were going to jump to this quite so quickly but I have the same concerns. Mr. Williams, you were going to discuss baseline psychological testing used to determine what the child’s brain looked like so that in the event if you believe they have suffered a concussion you have the ability to compare based on the baseline. Is that something you are prepared to talk about?
Mike Williams (Howard County Md, Director of Athletics): Yes, Ms. Staton.
Donna Hill Staton (MdSBE Board Member): And so I appreciate it to the extent that, we are talking about training, I think there really is an issue and what we really need to hear is what we are going to do beyond just training people in terms of identifying when they [concussions] may have occurred. And I have two daughters, athletes, who have suffered concussions so I have some experience with this.
And I know there are discussions in every sport about what could be done or what should be done. In soccer, should goalies wear head gear? In lacrosse, some wear protective covering, girls do and boys don’t—or is it the other way around? So there are a lot of issues that we really should be exploring. Pop Warner football league has banned some of these practices that we have been discussing. It’s not just the NFL.
So there is a lot of information out there. I do think this is the time to discuss it. We do have responsibilities to explore. And we can take steps to manage this. We don’t need a whole lot of hard data. If someone gets hit in the head, they’re hurt. What can we do to minimize that kind of injury that can have life-changing consequences. And I don’t know what some of the resistance to that concept is. Maybe we need to hear more about this and go beyond just educating people.
Mike Williams (Howard County Md, Athletics Director): Thank you. Good afternoon everyone. We began our concussion management program back in 2006 and implemented it in the fall of July 1, 2007. And part of that program was, at that time was voluntary optional ImPACT testing. ImPACT testing stands for Immediate Post Concussion Assessment and Cognitive Testing and as you mentioned it is a series of neuro-psychological tests. I would like to also add that as we developed our concussion program a number of the people that testified in front of the General Assembly, Dr. Gerry Gioia, from the Childrens’ National Medical Center, he has been part of the protocol in Geneva, Switzerland that developed the Zurich Concussion Protocol  for return-to-play. And Diane Triplet who was president at that time of the Brain Injury Association of Maryland and a number of professional folks. They are the people that guided our journey into concussion management in Howard County.
To give you a quick overview of the test. It takes about 20 minutes. You have to administer the test under strict environmental structure. As strict as you would an SAT or an AP exam. So you want temperature control, no noise, no cell phones, no Ipods, no interruptions. You take the test very seriously because you want the results to be reliable and you can verify later.
It is one tool in the toolbox. And the ImPACT folks will tell you that making return to play decisions should never—ImPACT should never be used as a stand-alone tool or as a diagnostic instrument. Again, it is one tool in the toolbox. We require that all our students in selected sports, sports that are contact or collision sports, be baseline tested prior to the beginning of the season. It is an eligibility requirement. And if they don’t have that test then they can’t practice until we have the test implemented.
Our athletic trainers give the test. They are trained every year and annually by Dr. Gerry Gioia of Childrens National Medical Center. He reviews the standards of care and best practices in our August meeting. So they are brought up to date annually. We also share with the coaches, we do require the on-line education thing as well. It takes about 20 minutes the whole test is about 30 minutes. We don’t include more than 12 to 15 students in any one testing session, we don’t want . . .
Donna Hill Staton (MdSBE Board Member): If I could just interrupt you and I apologize but I know we are running out of time. I understand how important it is to document the event of a concussion, you have that tool. But I think that a lot of us are most concerned about what can be done—maybe there is not a lot that can be done—to prevent it, to minimize the risk of it in the first instance. That is really where . . .
Mike Williams (Howard County Md, Athletics Director): Well, that would be teach coaches—how they are trained to tackle or how to block. Or check with a stick in lacrosse. That would be a different thing.
Donna Hill Staton (MdSBE Board Member) You are not really prepared to talk about that today.
Mike Williams (Howard County Md, Athletics Director): Oh, I can talk about it but I mean it’s not part of ImPACT.
Donna Hill Staton (MdSBE Board Member): Is there anything going on now? Any discussions, any attempt to identify ways to impose rules or regulations that would be preventative in nature? That is really what we are trying to . . . .
Ned Sparks (MdSDE Athletics, Executive Director/MPSSAA Executive Director): There is no question that over the evolution of years whether it be equipment or rules that the games have evolved to become more safer. For example, we have seen facemasks put on football helmets. I mean obviously before that the great danger of injury was even more. But for example, some of the rules that came into play, they took out blocking below the waste. All right. Significantly impacted the amount of knee injuries.
Donna Hill Staton (MdSBE Board Member): We are talking about concussions.
Ned Sparks (MdSDE Athletics, Executive Director/MPSSAA Executive Director): I understand. We are just talking about you know, in that regard, there have been, for example, taking away face blocking in tackling, which was a big part of the spinal injuries. All right, So those rules when they came into play have taken those injuries down. Haven’t eliminated them. But have taken them down.
Most recently, the thing that is receiving a lot of attention is heat acclimatization. All right. And we know across the country probably 15 or so students in the last x number of years have died from heat illnesses. All right, that’s a preventable disease. Excuse me, that’s a preventable condition. We can prevent those kind of things. So the rules that are coming into play regarding those kind of things are coming into play and changing it. It’s a slow process. I just heard . . .
Kate Walsh (MdSBE Board Member): But should it be that slow? Can you just answer this: are we currently considering any actions that would prevent concussions from occurring? And if not, I would like to ask the Chair if we could perhaps have a more informed discussion.
Ned Sparks (MdSDE Athletics, Executive Director/MPSSAA Executive Director): Are there any actions we can take? Well we . . .
Kate Walsh (MdSBE Board Member): Are you currently considering any actions to reduce concussions?
Ned Sparks (MdSDE Athletics, Executive Director/MPSSAA Executive Director): Any additional actions from what we did in the law in the bill? No.
James DeGraffenreidt (MdSBE Board Member, President): Mr. Smith and then Dr. Marks.
Guffrie Smith (MdSBE Board Member): I think a key—overriding a lot of things that we do has to do with best practices. And I think we are not getting that information here. We are looking at what has been done and looking ahead. What actually is happening out there before it happens. We are not worried about what happens after it happens—yes we are.
But what kind of things are being done by Massachusetts, Howard County, Calvert County, others. I know that some people are doing some of those things. And so are they ahead of us? And so we want to know what kind of things, what best practices are out there? And that’s the kind of discussion that we want to have to make sure this kind of thing does not occur. And so we have some policies in place and some procedures in place that will make sure that this doesn’t happen. That’s the bottom line.
Renee Spence (Executive Director, MdSDE Office of Government Relations): The first concussion, that’s a good question, the first concussion legislation that passed in the United States was in 2009 and was in Washington State. In 2010, 10 more states joined on as far as concussion legislation, very similar to what we passed in Maryland in 2011. So we were part of beginning states to recognize this need for legislation. We passed legislation. Policies and programs for concussions has been developed by Mr. Sparks and a whole host of committee members that represent DHMH, Traumatic Brain Injury Commission members, Childrens’ Hospital, neurosurgeons. So Maryland did, because of the legislation, start with the policies.
Did the legislation state say promulgate regulations? No. And I think some of our local school systems are establishing from the guidelines policies that are much more detailed and they are probably the best practices that you haven’t heard about yet. Howard County is the leader. There are several other jurisdictions that are leading in this arena.
James DeGraffenreidt (MdSBE Board Member, President): Dr. Marks.
Ivan Marks, MD (MdSBE Board Member): We keep using the word, “concussion,” but what we are really talking about is traumatic brain injury. And I think if we accurately identify what it is we are talking about it forces us into the issues that are being raised by Ms. Walsh and my other colleagues.
This is not a State Department of Education issue; it’s a State of Maryland issue, within our State boundaries. And I think for the Board, to really have something to consider, it has to come from, maybe this group that has already been brought together, but it has to include folks from the Department of Health, it has to include a lot of other people. When I worked in other public positions, you don’t take a problem like this and we kind of talk to the other folks, that do what we do and talk to the local school districts and we decide what to do. This cannot be approached that way. It has to be approached through the kind of group that we talked about when you all first began your presentation.
So what I would like to do is, I would like to propose that we either get that group or another group that has a varied cast to come together to tell us how we can help. What is it the State Board of Education needs to do to be a partner, because it’s a public private partnership. I heard Childrens’ National Medical Center, I am sure there are other organizations that take this on.
A lot of work that is being done by our military right now. They’re looking at traumatic brain injury. And its really relevant to them because if our high school students are getting hit on the head a lot and suffering traumatic brain injury it impacts the kind of people we have in our job markets, not only in our military, anyway, I could go on and on and on but I won’t this time. I would just like to recommend that we have some organized interdisciplinary group of folks get together and then come back and say, hey State Board, this is our best understanding of what this problem is the best way for us to approach it.
And I want us to do that from the perspective that we talked about in our previous last discussion [discipline policy]: What is it we want? And what we want is a bunch of healthy non-brain injured young people graduating from high school and going out into the world. So if we start off with the goal, it kind of allows us to back into to the behaviors that we need now as that leadership, as the health and education and whatever sorts of leadership there is.
This is a huge problem. I would like to say that we stop calling it “concussion” and call it what it is, its “traumatic brain injury.” Every time you get one, it builds on the last one. So there is no such thing as kind of I got over this and now I am okay. You don’t start over again where you were before the first one. So that’s sort of clear information and clear recommendations from the experts out there who really do this stuff every day, I would find very helpful.
James DeGraffenreidt (MdSBE Board Member, President): I can’t really improve on anything that Dr. Walks has said because I think he has accurately expressed to you what the sense of this board is. And you will know to be true what I am about to say.
It’s hard for legislation to get passed. On one level, legislation tells you “this is what we the legislative body want to see” and the Governor signs it and everybody salutes that. But the reality is, there is another way to look at this. Just because they didn’t say go out and make regulations, I view this legislation as an expression from across the State [of Maryland] that people are concerned enough about traumatic brain injury that this legislation got passed and they don’t know quite what they want done about it, but they want something done about it. Right?
So we sit here as the Board of Education knowing that there are other subject matter experts out there that are much closer to the subject than we are in the health field that need to be engaged on this and we don’t even need to go as far away as the Childrens’ Hospital down there in D.C. I mean we have Kennedy Krieger right here where they are doing some of the best work in the world on things around the brain. You have Johns Hopkins, University of Maryland.
I would suggest that you all think about how this ought to be organized so that we can actually understand, as Dr. Walks said, what’s our role and how can we, as Ms. Walsh said, how can we satisfy ourselves that what can be done based on what is knowable and what work is going on and best practices and so on. How can we position ourselves to be satisfied that students in Maryland who are athletes or non-athletes who suffer head injuries are positioned so that we minimize the extent to which those types injuries occur?
I doubt we can get to the point to eliminate you know, reduce that number to zero. It would be a shame if, just because of the passage of time we missed the opportunity to prevent something that was preventable. And right now sitting here, we don’t know what’s preventable and what’s not.
You know, sure enough if somebody gets hurt there going to ask what did you all do about it?
Renee Spence (Executive Director, MdSDE Office of Government Relations): I think as a panel, we actually don’t know all the things that are out there. I know [reference to MSDE staff?] and other [MSDE?] divisions working with DHMH and doing things regarding health and instruction, so we would like to come back to you with what’s available.
Donna Hill Staton (MdSBE Board Member): Again, it hasn’t been said enough, what we are really talking about is prevention. All of the things we talked about today don’t have anything to do with preventions. And I know that this is a topic that won’t be popular because anytime you start talking about changing the game or possibly changing the game there is a lot of resistance. We need to have that discussion to see if there is anything we can do that would still allow the game but have the priority of protecting the health of students.
James DeGraffenreidt (MdSBE Board Member, President): Okay? We appreciate your presentation and you were good sports to allow us to take you in a different direction than you were prepared to go. But, you get the gist of where we think we need to go. So thank you.
Sayed Naved (MdSBE Board Member): Is there an expectation for them to come back?
James DeGraffenreidt (Board Member): Yes, I will be following up with Tony [Snow] as we set future agendas in consultation with Dr. [Lillian] Lowery [the new Maryland State Education Superintendent] and others we will be following up on that. I would now entertain a motion to go into closed session to discuss several legal appeals, draft opinions, and draft orders and internal board management matters.
If you read the transcript you will notice that perhaps the full grasp of concussions and education are not fully understood. And perhaps the MPSSAA is only doing barely enough when it comes to this. However they are not the only state in this situation, most if not all of the states (even those with legislation) have really just “first steps” in this matter. Hearn is correct with the reduction in hitting time, one thing is for sure; less exposure = less injury, period.