Story by Zak Koeske, for Politics Daily
WASHINGTON — Not long ago, a player who suffered a football-related head injury received a cursory evaluation that involved little more than a trainer wagging a few meaty fingers in front of the dazed player’s face and asking him to count them. The seriousness with which a concussion was treated paled in comparison to, say, a knee injury, which could keep a player out for weeks. Concussions were but a transient inconvenience to be shaken off and played through.
Not anymore.
Ten states have adopted laws governing under what conditions a student-athlete who has suffered a concussion can return to the playing field, and progress is being made on implementing a national law. But without federal money to pay for implementing a new U.S. mandate, some lawmakers fear that poor schools could end up unprotected and unable to comply.
“I doubt seriously if the inner city schools can afford it,” said Rep. Donald Payne, a Democrat from New Jersey. “I don’t know what the answer is, but we have to come up with some thought or some discussion because I am concerned that a number of these kids will not be diagnosed properly.”
Payne aired his concern in September at a congressional hearing on the Protecting Student Athletes From Concussions Act. The act, if passed, would require that schools offer academic support to a student-athlete who suffered a concussion and guide the student-athlete in deciding to resume sports participation, with the help of a multidisciplinary team that may include a health care professional, parents, a school nurse and an individual assigned by the school to oversee and manage the student’s recovery.
Another bill, the ConTACT Act, which passed the House on Sept. 30, calls for neurological baseline testing for each student-athlete prior to the season. That testing would serve as a guide in determining when an athlete who has suffered a concussion could safely return to play.
A doctor who works with athletes said that while struggles with money are real, they should not deter lawmakers from the effort. Dr. Stanley Herring, the team physician for the Seattle Seahawks, said that raising awareness and education — avenues free to schools — must be the first step. The allocation of federal money, currently a non-starter, would have to come later.
“If you want to see this penetrate the rural communities there has to be education and legislation, and then there has to be capacity to put resources in place,” said Herring, who lent his support to the nation’s first statewide concussion law, which passed last year in Washington and has become a model for other states.
Payne said that he was not optimistic about getting the legislation financed and that he believed it was unrealistic to expect that education alone will bridge the income gap.
Rep. Tim Bishop, a Democrat from New York who sponsored the Protecting Student Athletes From Concussions Act, was adamant that equity issues would be addressed by legislators.
“We have talked in each of our hearings about the issue of school districts that are not properly equipped right now to comply,” he said. “We’re not trying to slip this by anybody. We’re trying to raise awareness of the issue and create a framework where local school districts can be more effective in framing the issue.”
Bishop said that implementation may not be as expensive as people think. For example, he cited the possibility that coaches or teachers could be certified and double as athletic trainers.
“There are ways to work through this,” he continued. “In my district, there are several school districts that do baseline testing pre-season. It costs $2 an athlete. I can’t imagine, except in cases of the most hardship, that parents wouldn’t be willing to come up with that $2.”
The concussion management system operating in Howard County, Maryland — considered a model school district because it has certified athletic trainers in all 12 schools, performs baseline and post-concussion testing and provides athletes who suffer concussions with academic accommodations — costs about $400,000 per year.
Because the cost of caring for a child who suffers a severe brain injury can run into the millions, Dr. Gerard Gioia, a neuropsychologist at Children’s National Medical Center in Washington who advises the implementation of Howard County’s program, said that if just one traumatic brain injury can be prevented, the cost-benefit exists.
But even for schools that lack that kind of money, Gioia said that a district’s concussion program can still function adequately by relying solely on education, at no additional cost to the district.
“What’s most important to both the ConTACT Act and the Protecting Student Athletes From Concussions Act is the education and awareness campaign,” said Gioia, repeating what has become a common maxim among doctors, congressmen and school athletic officials. “The materials are already out there. It doesn’t actually cost us any money in Howard County to do this.”
Free resource materials are available from the National Federation of State High School Associations — an organization that sanctions interstate athletic competition and provides educational support for its state members — and from the Centers for Disease Control and Prevention.
Although individual state members of the federation operate autonomously, the vast majority have taken the cue and now require coaches to pass basic concussion knowledge tests before they set foot on a sideline. Within the first five months, 85,000 free interactive concussion courses had already been delivered across the country.
Prince George’s County in Maryland is one school district that exemplifies what can be achieved with a limited budget. The district cannot afford to enforce neurological testing or hire athletic trainers but it does require coaches to take a 20-minute concussion safety course and has used free materials provided by the CDC for years, said Earl Hawkins, the county’s director of athletics.
“Each system is doing what they can do and no one is oblivious of the issue and how important it is that we keep kids safe,” said Hawkins, who has been able to hold concussion awareness weeks this school year for free with the help of the Maryland Public Secondary Schools Athletic Association. “We are very, very cautious of kids whom we suspect of a concussion. Our coaches are well versed and understand what they have to do.”