The education of concussions is great, the legislation is in the right place but there is absolutely no accountability for instances where athletes are “failed”. Before I go on, I am not perfect, I have and will continue to miss some things here and there (I missed an ACL in football which bothers me). In fact, looking at the pressure I put on myself and hoping the world puts on my chosen profession of athletic training it may be a bumpy road. However, missing obvious problems of health and welfare of athletes when one is an athletic trainer is inexcusable. I implore anyone out there that feels I have missed something to call my ass to the carpet as well.
This brings me to something that I found in my inbox recently and it made me sick and should be handled. This particular incident occurred in a state that has similar mechanisms for concussions as here in Illinois. To create the back story on the “mechanisms” in play you should understand the state legislation and high school association concussion education;
- Players, parents and coaches all have been given information regarding concussions
- Officials have been given authority to remove player for concussion signs or suspicion including mechanism of injury (MOI)
- Once removed they cannot return unless cleared by approved medical professional (IL is ATC, MD, or DO only)
With that information here is the email from a fellow athletic trainer – emphasis added is mine – (obviously stripped of identifying information);
Still have a long road ahead of education.
I was at a basketball game Friday night as a spectator and watched a player bounce [their] head off the floor. Opponent had set a screen and athlete ran right into [defender], bounced off and landed on floor bouncing head off the floor. The player then rolled around on the floor grabbing head and could tell [athlete] was in pain. Time was called by the officials to attend to the player. MOI would strongly suggest concussion and right there warrant being pulled and not allowed to reenter. Coaches come out and eventually they get player up and walks [athlete] off. I made sure to observe jersey number as I had a feeling [the athlete] was going to go back in. I saw no one evaluate the player. After a few minutes, the player came back in. I’m not sure how long the player was in when they ended up on the floor again – again bouncing head off the floor. The player was subbed out and spent the rest of the game on the bench.
The player should have not been allowed to reenter the first time.
The coach and officials failed the athlete as did the “athletic trainer” that was listed on the program.
Was so frustrating to watch.
I stewed on it all weekend and did notify the [high school association] that the protocol set forth by the state was not followed by the coaches nor the officials.
The system failed that athlete.
The last sentence is absolutely correct, if we as a society are to put things like this in place to protect our student-athletes we must follow through. Yes, there will be mishandled cases – this is certainly not the only one in this particular state, ever, nor all over the United States – but when there is an issue people must be held accountable.
In these parts, when an official sends off a player they are “booked” and personnel is notified the player is not to return until cleared by proper medical personnel. That personnel is identified prior to the game and they are the only ones that can report to the official about allowing that person back into play.
In football I meet with the officials prior to the game to make myself known as the “concussion guy” on our sidelines (unless my team doc is there). When a traveling lower team arrives they know I will be the one making the call for them as well while they are guests. In basketball I notify the visiting coaches and officials that I will be the only one in the gym making the return to play call, unless they have an athletic trainer or MD/DO that is present at that moment. If they are not present prior to tip-off I inform them for the safety and liability of the school I will make all calls. In the spring sports it is more of the same, I am clearly identified as the medical professional that will be making the RTP on possible head injuries.
The point being that along with education we have to be proactive and clearly establish who we are and that we know what the hell we are doing. By doing this it reminds the coaches and officials of the mechanisms they are responsible for when dealing with a concussion.
Back to this case, it is entirely plausible that the officials missed the injury (they did call time out for it) – they officiate. It is less likely that the coach(es) missed the injury and knowingly removed the player because of the thought of injury. It should be considered abhorable if the presiding PROPER medical professional missed the injury or communication from coaches/player about injury (we turn our heads at times or even have to go pee so communication is key). It appears from our email and astute observer that a full screen/evaluation for concussion was not performed; WHICH SHOULD NEVER HAPPEN considering mechanism of injury. Now the kid possibly sustained two insults to the brain in succession… Good luck with a quick (8-14 day) recovery if being truthful.
Again: THE ISSUE IS NOT THE INJURY OF CONCUSSION; RATHER THE MISMANAGEMENT OF BRAIN INJURY. (see above)
The Concussion Blog 
Here are the magic words to make this much more simple. “The player then rolled around on the floor grabbing head”
The second a player goes for his head he or she is done. It won’t catch all the brain injuries, but I would have to think that there is a medical explanation that could state why someone would go for their head (other than it hurts) and the involuntary reasons they would do so or start to do so in that split second. Some won’t go for their head, but think about how many we can keep safer if we had that as a rule in all sports from college down to youth. When in doubt sit them out and going to the head after a collision is doubt.
They would hate that rule but I guarantee that when they get older and understand risk more than they would as kids and teenagers, they would become the biggest proponents of that rule.
The Lystadt laws in most states make sure no has any responsibilty and the NFL has no liability.
It was and is about appearances. We have law; no let’s continue with our past policies.
I have told my son’s story multiple times as he was left in a wrestling match to receive blow after blow to the head (and repeatedly grabbed his head) while the coaches, athletic trainer, and ref did nothing more than ask him if he wanted to keep wrestling. They all violated high school league policy and there were no consequences. Three years later, he still struggles daily and as I attend another of my children’s athletic contests, I see on multiple occasions young people grabbing at their heads after hitting them on the ground, ball, or another player. There is a policy and a law in place now but the reaction differs very little. Time after time they are put back in the game with little to no screening. There is even a picture on the sport’s website of an athlete grimacing and grabbing his head. He was never removed from any game. In a school athletic meeting, the athletic trainers discouraged parents from taking their children to a doctor if they had any injury because it would take longer to get cleared back for play than if the AT’s handled the case. Maybe the culture is changing in some places but not in my neck of the woods! And there is absolutely no accountability!
Obviously there are many concerns here. First of all, the lack of concern displayed by the medical professional onsite is very disturbing. I wouldn’t even fault her for “missing” a concussion if she had evaluated the kid and allowed RTP. Possibly upset, but have to recognize that sometimes things look worse than they truly are. All of us are going to miss things; you’re kidding yourself if you really believe you can achieve 100% perfection. But the fact that she didn’t even stand up to check on the kid is a huge problem!
Number 2 is the fact that the officials allowed the player to return if they had any suspicion of a concussion. It is important that THEY put the safety as a priority. They need to mandate clearance from a qualified healthcare provider.
Number 3 is the coach needs to better understand concussions. He is probably the one person in the gym (except for parents) who knows this kid the best. Also, he needs to demand clearance from a qualified healthcare provider.
Number 4, the hospital and the host school should be ashamed for not providing a qualified healthcare provider onsite for competition. Here in the state of Illinois, this individual would not be allowed to clear an athlete with a suspected concussion. She is not a doctor and she is not a licensed athletic trainer.