Precautions Taken While Dealing With Head Injuries

It was a simple football play: a hit that knocked a player down on his back. The defense rallied around its defensive back, while Johnathan Coleman took a few seconds to get back up on his feet.

It was in Boston College’s second scrimmage last Saturday that Coleman stumbled over to the sideline so the next play could ensue. Immediately, the athletic training staff went over to the wide receiver and sat him down on the bench. They asked him a few questions before Coleman tried to stand up so he could get back out on the field. But they sat him back down, as assistant athletic director of sports medicine Steve Bushee grabbed Coleman’s helmet and took it away.

Bushee took it away because the helmet needed repair, but it’s also what he would have done had Coleman been diagnosed with a concussion.

Per the NCAA rulebook, if any player has a concussion, he or she is done for the day, in any sport. In football, a member of the staff will take away a player’s helmet following the diagnosis.

A lot of times, that diagnosis will not come right away. Some concussions can be spotted immediately. At one end of the spectrum, an athlete could get knocked unconscious, and right away they are diagnosed with a concussion. At the other end of the spectrum, a player could get hit at an indirect angle, and still get concussed. He might stagger off the field, but even that doesn’t directly lead to an automatic diagnosis.

Most concussions are either self-reported or teammate-reported. Others are never reported at all.

Diagnosing concussions can sometimes be just as difficult as the initial discovery. Nonetheless, the BC sports medicine staff has a specific protocol for how it deals with any head injury.

First, the player is pulled out of the game per NCAA rule. They are sat down, and will undergo an initial assessment called the Standardized Assessment of Concussion (SAC). Bushee has the SAC form in his pack that he carries around at each game and practice. The trainer will write down the athlete’s name, sport, the date, the time of the initial injury, and the time that the player is being assessed. In most cases, those two times are very close together.

The first part of the SAC has questions about orientation (month, date, year). Then, there is a section on immediate memory. The trainer will read the athlete a list of words, and the athlete must repeat as many as he can remember, in any order. This happens three times, and everything is graded zero or one.

Non-scored parts of the SAC include the Romberg test to assess the athlete’s balance, and an evaluation of the athlete’s pupils to see if they are equal and reactive to light.

Then there will be a test to see if there has been amnesia-before or after the hit. Sometimes a player will forget things that happened leading up to the hit, but remember everything after. In other scenarios, a player will recall everything prior to the hit, but not the immediate seconds following it. Sometimes, in scarier situations, they don’t remember anything before or after the blow.

Next, the trainer will say a list of three to six numbers and ask the athlete to repeat the digits backwards. He will also have to name the months of the year in reverse order to further evaluate his concentration. Lastly, there is a section on delayed recall. Using the same words that the trainer used at the beginning of the test, the player will be asked to repeat as many as they remember.

With everything based on a points system in the SAC, the trainer will add up the athlete’s score. Every player has a baseline score that is recorded at the beginning of the season when he is not concussed. A low score does not mean the athlete is badly concussed, as each case is judged on an individual basis.

The SAC score is just one part of the evaluation. The trainer will also talk to the athlete and go through a checklist of symptoms: headache, vision issues, nausea, difficulty concentrating, in a fog, and the list goes on.

All cases are handled on a day-to-day basis, depending on the athlete’s signs and symptoms. BC’s return to play progression for players with concussions is at the very least four days. In a best case scenario, the athlete will be sideline for four days, being reevaluated daily. Once the trainer determines that the concussed player is symptom free, he can go back to practice, but not yet back to full contact.

In recent years, there has been an increased awareness of concussions in sports. There haven’t necessarily been more concussions, but more teams reporting them.

Just in the last year, there have been a handful of BC athletes who have sustained concussions: Nick Clancy, Michael Giacone, and Spenser Rositano in football; Michael Matheson and Brian Billett in hockey; Andrew van Nest and KC Caudill in basketball. And those are the ones reported by coaches to the media. Many more happen each day.

Years ago, it used to be that if an athlete had three significant or grade-3 concussions, his or her playing days would be over. Now there is no magic number. For the most part, they are no longer graded for their severity. More important indicators are how many concussions an athlete sustains, and how many symptoms they experience with each one. Their recovery time is also an important factor, as is the amount that it takes to suffer a concussion. If it starts taking less and less to sustain one, trainers will start to worry.

Yet, a bigger force of a hit does not necessarily mean that an athlete is more likely to get a concussion. UNC athletic trainer Kevin Guskiewicz has shown evidence of two different scenarios that dispel that myth. His research has maintained that force of blow is not directly related to whether or not an athlete gets a concussion. Often, rotational force figures into the equation. Concussions can often occur from blows that are not straight on, but a submaximal glancing blow that causes a rotation of the head.

New NCAA rules that attempt to minimize blows to the head may help to limit the amount of concussions sustained each year in college football. There will always be new helmets, but as of right now, there is no such thing as a concussion-proof helmet. Neither helmets nor mouth guards can prevent concussions.

Rules will likely continue to evolve, as will the equipment involved in football, but concussions will always be a part of the game. So will dealing with those concussions. As research continues on the issue, trainers will continue their multi-prong approach to diagnosing and evaluating concussions, based on cognitive and physical symptoms.

There will be more concussions at Alumni Stadium next fall. How they affect the future of football remains to be seen.

April 18, 2013