More than 18 months after the deaths of two North Carolina high school football players from head injuries, more than half the state's public high schools do not have certified athletic trainers despite recommendations from the state's high school sports safety committee and one of the top concussion experts in the nation.
Because of a lack of funding, only 156 of the N.C. High School Athletic Association's 379 member schools have a certified athletic trainer, according to the N.C. Athletic Trainers Association. Hiring trainers for all schools, which would cost about $21.5 million, was a key component of the guidelines developed by the safety board after the concussion-related deaths of the two football players during the 2008 season.
The guidelines also included requiring a physician's approval before a player can return to action after a concussion.
Instead of certified athletic trainers - who are medical professionals - the other 223 NCHSAA schools, as required by law, use first responders, who are trained in first aid, cardiopulmonary resuscitation and injury management.
"Certified athletic trainers save lives and help prevent suffering," said Kevin Guskiewicz, chairman of the UNC Department of Exercise and Sport Science and the director of the Center for the Study of Retired Athletes. "Everyone agrees with that."
Schools take the lead
Some schools have hired trainers, even without state funding. Of the 78 schools that are members of the N.C. Independent Schools Athletic Association, 24 have certified athletic trainers. Among the NCISAA's 19 larger schools, the 3-A division, 18 have certified athletic trainers. All of Wake County's public high schools have certified athletic trainers, and all the Durham County schools have budgeted for certified athletic trainers, although the trainers at Hillside and Southern Durham recently resigned.
The danger of concussions, which are caused by a severe shaking of the brain within the skull, has become an issue at all levels of athletic competition. On Monday, the U.S. House Judiciary Committee, which has already held two hearings on head injuries in the NFL, has scheduled a forum in Houston to look at how high schools and colleges handle the problem.
Although the state's public high schools have detailed guidelines for handling sports-related head injuries, the NCAA does not have a universal policy on concussions and depends on individual schools - including UNC, Duke and N.C. State - to develop their own programs.
"The purpose of the hearing is to improve the manner in which concussions during sporting events, football in particular, are treated," said U.S. Rep. Howard Coble, a Republican from Greensboro. "Some medical reports indicate that these injuries can be linked to long-term injuries such as dementia, memory loss, Alzheimer's and other maladies. I think it is an issue that needs very thorough attention."
Deaths spurred action
The North Carolina high school association began urgently talking about concussions after the deaths of junior Jaquan Waller at Greenville Rose High and sophomore Matt Gfeller at Winston-Salem Rey nolds during the 2008 football season. Both died after head injuries, and neither school had a certified athletic trainer.
The NCHSAA's Sports Medicine Committee met in emergency session in October 2008 and heard recommendations that trainers be mandated in the state's secondary schools.
"This is a public health issue," Guskiewicz told the committee. "We need to say the safety and health of our high school athletes is a priority."
Guskiewicz laid out a broad plan to the committee, which was made up primarily of physicians and athletic trainers. He said that if athletic trainers could not be in place in the high schools, the alternative should be for high schools to eliminate football, boys and girls lacrosse, boys and girls soccer and wrestling until a school system had enough money to hire a certified trainer.
No states mandate the presence of certified athletic trainers for every secondary school.
At the association's board meeting that December, the NCHSAA passed the measure requiring a physician's OK before an athlete can return to action after a concussion. It also recommended athletes get baseline testing to show normal cognitive function in case the athlete was later injured.
But, because of a lack of funding, the board did not require its member schools to have certified trainers, and the association agreed to ask the legislature to mandate and fund athletic trainers in secondary schools.
"The consensus was the NCHSAA couldn't mandate without providing funding," said Rick Strunk, an associate executive director.
The odds are not good that the legislature will fund the initiative anytime soon.
Bills were introduced into the state House and Senate last year that would have funded and mandated that every secondary school have a certified athletic trainer. The appropriations bills were not funded, effectively rejecting the effort.
"I'm proud to have sponsored the bill, but in terms of funding, when you have a $4.6 billion shortfall, I understand why it was not funded," said state Sen. Don Davis, a Snow Hill Democrat who co-sponsored the Senate bill with Sen. David W. Hoyle, a Gaston County Democrat.
Hoyle said getting certified athletic trainers in the schools is still important.
"We've had children die in North Carolina and other children return to play before it was safe. There have been serious injuries," Hoyle said. "We need the trainers."
A concussion is a traumatic brain injury caused by the shaking of the brain by a blow to the head or body. The brain is surrounded within the skull by cerebral fluid. Picture an egg yolk surrounded by egg white within a shell. If the head is shaken severely, the brain can hit the skull. The damage done to the brain is a concussion.
Professional football has come under increasing scrutiny as studies showed the long-term impact of multiple concussions. A number of studies published from 2004 to 2007 have indicated a substantial link between NFL players' head injuries and later-life risk for depression, Alzheimer's disease and cognitive impairment.
Among guidelines recently mandated by the league, NFL players who exhibit any significant sign of concussion are required to be removed from a game or practice and are barred from returning the same day.
Guskiewicz said the emphasis the NFL is placing on concussions should help college and high school athletes.
"I think what the NFL has done so far is good," Guskiewicz said. "Anything we do to help get us away from the idea of playing with a concussion is a sign of manhood is helpful."
Earlier this month, the NCAA Playing Rules Oversight Panel supported the concept of concussion-management proposals that include athletes leaving play if they show concussion symptoms and not returning until cleared by a physician or a physician's designee. The committee asked each sport rules committee to look at its rules and policies.
A common injury
Virtually every high school football team in the Triangle area had players miss games because of concussions last season.
Millbrook looked like a power before quarterback Trey McFarland was lost to a concussion, but coach Clarence Inscore said he was more concerned with his players' health than their impact on the field.
"As coaches, we want to do everything we can to keep our players safe," he said.
Janna Fonseca of Carolina Family Practice and Sports Medicine said her organization treated between 150 and 160 area athletes for concussions between August and December.
The organization also provided free baseline testing for Wake County public schools this year but is not expected to do so next year. Bobby Guthrie, the Wake County schools athletic director, said schools have been told to allot about $500 each to provide the cognitive baseline testing for the 2010-11 school year.
"Hopefully, the schools will find someone in the community who will help cover the cost," Guthrie said.
How testing helps
The tests show cognitive ability before injury. Other tests measure balance and reaction times. After a concussion, athletes take the tests again to see how well their injury has healed.
Medical professionals say youth sports injuries are increasing.
Julie Pulice of the National Athletic Trainers Association, said at the organization's sports safety summit held last week in Sacramento, Calif., that at least 115 school-aged children died from athletic injuries or related problems from Jan. 1, 2008, to Jan. 10, 2010. Seven athletes died in North Carolina during that period, including two college athletes. In addition, an eighth-grader died during a physical education class.
"There are a lot more fatalities from heat related problems, cardiac problems and head injuries than most medical professionals expected," Pulice said.
Ken Brown, a certified trainer at Northern Durham High School, said his colleagues are not about to give up on helping the state's young athletes.
"We're not going to lose our resolve. I think most people know these trainers are needed."
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