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Children's Health

First Line of Defense: Playing it Safe with Concussions

A UNC symposium reminds athletic trainers that their first responsibility is to protect the student-athlete.

By Taylor Sisk

“Be educated, be conservative, use your common sense, and know that lawsuits will become the norm.”

UNC v Georgia Tech, 2009

UNC at Georgia Tech, 2009. Image courtesy hectorir, Flickr Creative Commons

Those were the parting words of Gary Wolensky, a lawyer who has litigated numerous cases involving sports-related brain injuries, speaking at the Matthew Gfeller Neurotrauma Symposium, held last Friday and Saturday at UNC-Chapel Hill’s Loudermilk Center for Excellence.

Wolensky was speaking to an audience of some 250, most of whom are high school and college athletic trainers. The central theme of the symposium was “Play it Safe” – take no chances in your response to a potential head injury; your primary responsibility is not to the school, the team or the coach, but to the athlete.

Attendees were brought up to date on the latest developments in injury management, clinical research, equipment and legislation.

And on how to avoid litigation. To which the answer is: “Play it Safe” – always put the safety of the athlete first.

The National Football League will soon be faced with a class action suit alleging that the league purposefully concealed information on the neurological risks of concussions and exposed players to dangers that could have been avoided. Several thousand former players will be plaintiffs in the suit.

But if anyone at last weekend’s symposium was in favor of dramatically altering the rules of contact sports, or banning them altogether, they were in a distinct minority.

“Matthew was all football,” said Bob Gfeller, in his opening remarks Saturday morning. UNC’s Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center is named in honor of Gfeller’s son, who, on Aug. 22, 2008, died after a severe helmet-to-helmet collision during his first varsity football game at R.J. Reynolds High School in Winston-Salem.

Matthew Gfeller, Image courtesy Matthew Gfeller Fdn.

Matthew Gfeller. Image courtesy Matthew Gfeller Fdn.

But Gfeller and his wife, Lisa, aren’t anti-football; they’re dedicated to seeing that contact sports are played as safely as possible.

“People get hurt playing football,” said Jason Mihalik, co-director of the Gfeller Center and co-chair of the symposium. “But more kids get hurt riding their bicycles or getting [traumatic brain injuries] in motor vehicle accidents. Are you going to tell high schoolers you can’t drive anymore because you’re going to get a concussion?

“To say you can’t play football because of that same fear seems a little irrational to me.”


Certainly, the weekend’s speakers agreed, more must be done to protect young athletes, and, several noted, that’s more likely to result from heightened awareness and greater scrutiny than more-protective equipment.

“Since that 2011 meeting,” Mihalik said, referring to the last Gfeller-sponsored neurotrauma symposium, “we’ve looked at things like the influence of vision and the importance of being able to cue in on your surroundings and anticipate collisions.”

“We’ve started scrutinizing more the infractions that cause injury that aren’t being called by the officials on the field,” he said. “In hockey, it’s elbowing and head contact; in football, it’s head-to-head hits, and we see those being called more frequently now.”

Legislation has played an important role as well.

In 2011, the North Carolina General Assembly passed the Gfeller-Waller Concussion Awareness Act. The law mandates the development of an athletic-concussion safety training program for athletic directors, coaches, school nurses, volunteers and student-athletes and their parents.

anatomy of a concussion

A concussion is a traumatic brain injury that changes the way your brain functions. When the skull is jolted or impacted by a hard surface, the brain shifts, slamming against the skull, causing damage and swelling to the brain. If treated correctly, the brain will heal. But if not, results can be deadly. Image courtesy Max Andrews, wikimedia creative commons

It requires athletes who show signs of concussion to be removed from the game and not be permitted to practice that day or any subsequent day until being evaluated by and receiving written clearance from a qualified health professional.

It also requires schools to develop emergency plans and maintain records.

Tamara Valovich McLeod, a professor in the athletic training program at A.T. Still University in Mesa, Ariz., told of an initiative launched by the Barrow Neurological Institute, the Arizona Interscholastic Association and the Arizona Cardinals. They’ve created something called the Barrow Brainbook, modeled after Facebook, an interactive course for student-athletes that explains what a concussion is, the symptoms and ways to try to protect yourself.

“Instead of just reading it, the student-athlete must interact with it,” McLeod said. They can “like” things and “dislike” others, and are introduced to characters. “We’ve got Daredevil Dan,” McLeod said. “He doesn’t care if he has a concussion, so hopefully they’re disliking everything he says.”

Athletes aren’t eligible to participate in interscholastic sports until they’ve completed the course and passed a test. “Our interscholastic association has really stepped up,” McLeod said.

Other states are now evaluating implementation of the Brainbook.

No more ‘old-school’

A short video clip: Two small boys, probably 5 or 6 year olds, fully outfitted in football gear, go into the three-point stance, facing each other, perhaps two feet apart. A whistle blows, and the boys hurtle forward, colliding helmet to helmet; one gets up, the other lies crying.

Tamara McLeod headshot

Tamara Valovich McLeod

The audience cringes and groans. The clip speaks volumes of the need for more fully disseminated awareness of how concussions are sustained and what must be done to avoid them.

Legislation has helped in improving that awareness, McLeod said, but, “We need to continue to move forward; we must advocate for continued change.”

There remain “old school” coaches, she said, who must be brought on board. But, she added, initiatives must include teachers, counselors, school nurses, parents – a collaborative approach within communities.

Steve Pachman, another lawyer who spoke at the symposium, said that it used to be that the student-athlete was considered to hold primary responsibility for the risk of injury, having knowingly assumed that risk and voluntarily elected to play. No more, Pachman said, reminding this crowd of health care professionals that it’s first their responsibility, and that it’s their duty to see to it that the safety of the athlete comes first.


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