Wednesday, April 13, 2011

Frontline Report "High School High"

Last night's report by Frontline on PBS was a sobering view of the commercialization of high school football. The show featured a small, private school in Arkansas who decided in the 1990s that they wanted to be able to compete at an elite level. It took several years, but their very significant investments recently started to pay off with very big dividends. They were repeatedly competing for state titles and attracting high quality athletes to move into the area to enroll. However, the report also showed that the increases in the program have not been without some serious drawbacks.

The report discussed what the excesses in one program creates via competition in neighboring and rival programs and, eventually, how they impact the game itself. The size, strength, and speed of high school teams today are growing at a very rapid pace. Because of these increases, the force of the collisions are increasing as well. This has led to some staggering statistics in the amount of TBIs that have occurred across the country. 60,000 TBIs are reported in the US due to high school football per year according to this report. When you combine that with the statistic that only about one third of high schools have a full time AT on staff to manage the injuries, this number gets even more intimidating.

Also included in this report were several quotable lines that I found appalling. "We don't cancel practice because of the heat" was one of the quotes that I really had a hard time comprehending. Granted, northeast Ohio is not the same climate as Arkansas and Texas and the heat is a concern for them all season log. (Up here, issues with heat are rare after week 3 of the season in early September.) I am sure that the heat index also climbs higher with greater frquency than it does here, so I understand that practice has to happen at some point. However, I wish the report would have stated that these practices are altered to accommodate the climate when it does get excessively hot. I am fairly sure that happens regularly.

The other quotable line in the documentary was regarding the return to play status of an athlete with a TBI being based, in part, on the game situation. There is not a single coach or AT at this point that should be unaware of the current standards of practice that would preclude returning an athlete with a TBI to play in the same game. I found this to be exceptionally disturbing and the coach to almost be bragging about his bravado in the situation.

With all that was presented in this documentary, I do have one big critique on it. This project paints coaches in a VERY negative manner. The film claims that the external pressures to have and maintain a winning program are so great that it often corrupts the coach into making poor choices. While I am not naive enough to believe that this doesn't occur, I have maintain that, at least for everyone that I have worked with, that this is just simply untrue. The overwhelming majority of coaches take their commitment to the kids they work with very seriously and would never knowingly put a youngster in an unacceptable situation. The coaches and school administrators that I currently work with daily are a testament to this assertion. They do understand that, in the end, it is their responsibility to educate the kids and guide them to being responsible adults, not to win at all costs. I do wish that the report would have indicated somehow that this is not, by any means, the majority of coaches that would risk a kid's future to win a game.

If anything, I usually get greater resistance to holding a kid out of game from parents and the athletes themselves, not from the coaches. I think that this is where more education is required and that films like this will at least spawn healthy discussions about these topics.

Addendum: After an online discussion with the film maker in an online chat, she reassured me that the coaches that she interviewed were more caring for the kids than I thought they appeared to be in the video.  This was very reassuring.

Wednesday, April 6, 2011

New Legislation in Ohio on TBIs

The Ohio legislature introduced on March 7, 2011, a new bill that will change the way TBIs are handled in all youth athletic programs, not just the scholastic programs.  The TBI bill (HB143), as it is currently written, will mandate several steps when dealing with head injuries in youth.  In a letter from the Ohio Athletic Trainers Association President, Hollie Kozak delineates what these changes will be.  She summarizes the mandates this way:

"As currently drafted, the legislation requires both school sponsored sports and “youth sports organizations” to adhere to the following requirements:
1.)     Requires students to submit a form signed by their parent stating that the parent and the student have received concussion and head injury information sheet
2.)     All coaches must hold a pupil activity permit (PAP) for coaching interscholastic athletics, and requires the (PAP) to develop additional training program specifically focused on brain trauma and brain injury management
3.)     A coach shall remove from practice or competition a student suspected of having sustained concussion or head injury during a practice or game
4.)     A student shall not be returned to practice or competition on the same day they were removed
5.)     In order to return the student to play: the student must be assessed by a physician, or athletic trainer and must have written clearance to return to play or practice.
The Ohio Department of Health would be the regulatory body to oversee the program."

The legislation was cosponsored by several interested parties including the Ohio American Academy of Pediatrics (OAAP), the Ohio Brain Injury Association (OBIA), Nationwide Children’s Hospital, and the Ohio Children’s Hospitals Association.  The bill was introduced by Representatives Michael Stinziano and Sean O’Brien and has many legislative cosponsors.  This is the same legislation that the National Football League has also endorsed in many other states, and I assume will do the same here.  

With all of the support, I  suspect that this will be run through fairly quickly and will be in place before the fall season of 2011.  Assuming it will be passed, this will make for a mad scramble for youth leagues to get all the necessary paperwork in order and be ready for the start of their seasons.  In our community, I have already reached out to all three organizations that run the local athletic programs and will be offering educational programming for all the youth coaches.  The best place to access a lot of this information at this time is through the CDC website where they offer a great deal of educational materials at no cost.

The hospital system that I am employed by is also looking to do a few other things for the various leagues and we should be hearing about them shortly.  Hopefully, this will allow us much greater access to all the youth living in the school districts in which we are currently employed.

Friday, April 1, 2011

An Encouraging Sign

Very often, athletic trainers find themselves at the front of the educational push to increase the awareness of a health related issue amongst the athletes they serve.  This has certainly remained true with the latest issue, TBI. Usually, we find ourselves frustrated to no end trying to educate our clientele as to the intricacies of an injury, only to have somebody suffer the injury we were warning them about.  The infuriating phrase "I never heard you say that" or the same old, outdated argument(s) are often the excuse given by the athlete.  We then wonder how much of our effort was actually worth it and should we really keep plugging away at trying to educate people.

I can finally say yes, it is absolutely worth it.  Earlier this week, I was discussing an unrelated injury with an athlete when he mentioned to me "I hit my head playing a soccer game this weekend and I think I might have a [TBI].  At this point, I pulled out my testing materials and began to examine him.  Sure enough, through the interview process and discussing his symptoms, he scored high enough that I believed that he had a TBI.  When I asked him what made him think that he had a problem, he cited the large amount of press coverage that the topic was receiving and that he thought he better get it looked at.  I commend the young man for being so proactive and taking the necessary steps to take care of himself appropriately.  Maybe, just maybe I will be able to see a little more of this responsibility and less of the macho "leave me alone, I can handle this" attitude that is usually associated with this injury.