When 13-year-old Adrianna Mitrano told her parents she’d be skipping spring sports in favor of the school play, the announcement came as a relief. No more concussions, Leslie and Scott Mitrano reassured themselves — at least for the time being.
Their daughter had suffered two concussions since last September playing field hockey and basketball at Otter Valley Union Middle School in Brandon. Both head injuries occurred as a result of collisions with other players. In each case, it was her parents — not teachers, coaches or athletic directors — who first suspected a concussion.
“Their focus is more on the game than the players on the sidelines,” says Leslie Mitrano. While she doesn’t blame coaches, she wishes school sports officials were “more educated” about concussions — temporary brain injuries that can wreak havoc on concentration, memory, judgment and coordination.
Better education was the goal of a 2011 law that requires Vermont high-school coaches to get hands-on training to better recognize concussions on the field. Now a handful of lawmakers, coaches and athletic trainers are pushing for even stronger rules, which they say would better protect more students from the potential long-term effects of sports-related head injuries.
Senate bill S.4 would put trained medical personnel on the sidelines at some of the most dangerous high school sporting events. “If you’re concerned about student athletes’ safety, this is a bill you should be supporting,” says Sen. Dick Sears (D-Bennington) S.4’s lead sponsor and a former football player himself.
Under the current law, all high school coaches receive a brief training — less than a half hour — that alerts them to concussion symptoms. Schools send out educational materials about head injuries to student athletes and their parents. An addition made last year requires coaches to remove a player from the field if the coach suspects a concussion. The player can’t return to the game until a medical professional gives him or her the green light.
But that’s not enough, according to Sears, who volunteered as a football coach last year at Montpelier High School. He says he saw coaches sometimes get “caught in the middle” between doctors who cleared students to return to play and athletic trainers who kept the players benched. Sears worried about students who downplayed possible concussions because they didn’t want to miss matches. And the quality of the medical services at away games varied wildly.
Alan Maynard, president of the Vermont Association of Athletic Trainers and the director of the University of Vermont’s athletic training program, seconds the senator’s concerns. He says many Vermont high schools don’t have athletic trainers or medical professionals at many sporting events, where concussions — not to mention other potentially serious sports-related injuries — are a risk.
“We don’t even meet a minimum standard at this time,” says Maynard, who also works as an athletic trainer at Bellows Free Academy in Fairfax. Tighter rules, he said, are the “very tip of the iceberg” when it comes to better protecting student athletes.
Sears’ bill would require home teams to provide medical professionals on the sidelines at high school “collision sports events.” At present, the Vermont Principals’ Association only mandates medical professionals at football and hockey games but does not specify that they have training in concussion diagnosis and treatment. Medical coverage is recommended, but not required, for other sports.
Sears wanted the new legislation to cover all contact sports, but a compromise version the Senate passed on March 14 requires medical personnel only for football, ice hockey, wrestling and lacrosse.
Additionally, referees would need to undergo concussion training, which currently isn’t required, and schools would be required to draft explicit concussion management plans, outlining who makes the final call about removing a student from play and allowing that student to return.
Senate passage kicked S.4 over to the House Education Committee in time for the legislature’s “crossover” deadline. But in a House hearing last week, some members seemed surprised the subject was before them again just two years after they passed the 2011 bill.
“I’m not sure why we’re coming back to this so soon, and I’m not hearing anybody knocking on the door for us to address this,” Rep. Johannah Leddy Donovan (D-Burlington), the committee chair, said at the April 3 hearing.
“I personally feel like, if it ain’t broke, don’t fix it,” agreed Rep. Valerie Stuart (D-Brattleboro).
To that, Sears responds: “Let me tell you, it’s broken … I think the idea that ‘if it ain’t broke, don’t fix it’ is really kind of callous toward student athletes.”
Not long ago, concussions were dismissed as nothing more than a bump on the head. Athletic trainers like Maynard and South Burlington High School’s Denise Alosa say their profession has long recognized the seriousness of the injury — particularly when an athlete suffers multiple concussions without sufficient time for healing — but coaches, parents and athletes weren’t always clued in.
Take it from John Murphy, now the head coach at Montpelier High School.
“I come from Rutland, and Rutland is a hard-nosed football town,” says Murphy, who was a quarterback, wide receiver and defensive back for Rutland High School in the late 1990s and later coached youth football in the area.
“It was, ‘You get popped, you get back up, and you suck it up.’ You sort of got your bell rung … and it was a rite of passage.”
Murphy says that attitude has changed dramatically in the decade since — both in Vermont and nationally — as concussions among young people have increased and national attention has been directed at the severity of concussions in professional sports such as boxing, football and hockey. From 2001 to 2009, the number of emergency-room visits attributed to brain-injured young people jumped almost 62 percent nationally, according to the U.S. Centers for Disease Control and Prevention.
In response, 43 states have passed legislation since 2009 to keep student athletes with head trauma from getting reinjured. Washington State led the charge with the so-called Lystedt Law, named after Zackery Lystedt, a middle schooler who sustained multiple concussions during a football game in 2006. Lystedt spent three months drifting in and out of a coma and eventually had to relearn how to speak, move, eat and drink.
Washington credits the law with reducing head injuries on the field. Prior to its passage, at least one student a year required surgery for a subdural hematoma; since 2009, no such incidents have been reported.
Vermont doesn’t track concussions among young athletes statewide, though some trainers and coaches keep their own school records. At SBHS, Alosa says concussions make up the greatest proportion of injuries in boys’ lacrosse, girls’ ice hockey and snowboarding. Football ranks fifth. Over the last five years, Alosa has documented 81 concussions — or an average of 16 per year — at the high school.
At last week’s hearing in Montpelier, some questioned whether stricter rules would be a burden for smaller schools on tight budgets.
“In an ideal world, every school would have a full-time athletic trainer,” Matt Gammons, a doctor with the Vermont Orthopaedic Clinic, told the House Education Committee by telephone last week. But that’s expensive, and sometimes rural schools can’t find appropriately trained professionals, Gammons and others said.
VPA associate director Bob Johnson told legislators that athletic directors anticipated a cumulative $40,000 to $50,000 increase per year in spending statewide if the proposed rules went into effect — primarily due to the added expense of having licensed medical professionals such as athletic trainers or doctors on the sidelines for collision sports. Currently, only seven of the state’s 38 high schools have trainers on the sidelines for all five of the sports singled out in S.4.
“I know this is not a lot of money, but school budgets are already in place,” Johnson said, adding that if concussion rules were expanded — to cover elementary and middle schools, for instance — the repercussions would be “huge.”
But Maynard calls the cost a “minimal investment” that’s necessary to protect kids. “If we’re not going to put safety first, then maybe we shouldn’t have these sports,” he says.
Meanwhile, Mitrano suggests parents should take the initiative to learn more about head injuries. When her daughter complained of a headache and impaired vision, she and her husband were first to recognize the classic symptoms of a head injury.
But some parents make it worse. Maynard has seen “overbearing” ones call up a doctor to request a note clearing the student for play, even though the student may still be exhibiting symptoms of a concussion.
“It really takes a village around these things to be able to intervene on young athletes’ behalf,” says Maynard. “Especially if they get hit in the head, they may not make great decisions around their health. At that age they think they’re invincible
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