RALEIGH — High school football has changed in North Carolina since two fatal brain injuries shook the sport in August 2008.
Jaquan Waller at Greenville Rose and Matthew Gfeller at Winston-Salem Reynolds died days apart after head injuries suffered during high school football games that season, and their deaths have led to changes in awareness, medical protocols and legislation.
Concussion awareness is one of the best things to ever happen to high school football in North Carolina, veteran Northern Durham coach Gary Merrill said. Nothing is more important than the players safety.
Waller, a 16-year-old running back for J.H. Rose High, suffered a concussion during a practice, but the traumatic brain injury was not diagnosed and he did not see a physician. He played in a game later that week and died of second impact syndrome when a collision jarred his already injured brain.
Gfeller, a 15-year-old sophomore linebacker for Reynolds High, died after suffering a severe head injury during a game that same year.
The deaths of Waller and of Gfeller led the N.C. High School Athletic Association to call an emergency meeting of North Carolina health professionals that created a revolution in how the state deals with concussions.
Greenville Rose, which has become a leader in concussion awareness, is one example of how athletic programs throughout the state have changed.
Recently when Rose football coach Todd Lipe looked over the injury report from the schools certified athletic trainer, the list included a broken thumb, a pulled hamstring, a sprained ankle and four possible concussions.
We treat anyone with any concussion symptoms the same as we would someone who we know has a concussion, Lipe said. You want to keep the kids safe.
A game of hitting
Coaches and athletic professionals are charged with keeping the athletes safe because injured athletes often are more interested in playing than in recovering. Despite the changes in concussion management and the education of coaches, parents and players, players want to play.
Southeast Raleigh High wide receiver and safety Dante Jones spoke for many high school football players when he recently wrote on his twitter account, Watching these videos in sports med about concussions and people dying is making me soft *closes eyes and ears*.
Jones later said he appreciates the seriousness of brain injuries, but said that football is a game of hitting.
I understand why we watch the videos and learn about concussions, Jones said. But concussions are going to happen. It is a part of the game. If you play football, you are at risk of getting a concussion.
Concussions are changes in the chemical activity in the brain that are caused by the brain being jarred or shaken in the skull. The brain needs rest to recover, but medical professionals cannot forecast how long a specific concussion will take to heal.
Approximately 80 percent of concussed athletes recover in 7 to 10 days, but symptoms can linger for weeks, months or even years, according to Robert Cantu, co-director of Boston Universitys Center for the Study of Traumatic Encephalopathy. If the brain has not healed, the brain is more susceptible to another, possibly more serious injury.
The Centers for Disease Control and Prevention said children up to 4 years old and adolescents between 15 and 19 are most susceptible to concussions. There were 67,000 diagnosed concussions among the 1.1 million high school football players in the U.S. in 2010, the last year the total was available.
The CDC said the concussion rate is increasing, having doubled in the past decade, but some of the increase is because coaches and athletic trainers are more aware of concussions than they were 10 years ago.
Cantu believes far more concussions go undiagnosed than are reported.
The North Carolina Legislature passed the Gfeller-Waller Concussion Awareness Act in 2011. The legislation established a concussion protocol for North Carolina public middle schools and high schools and required schools to have an emergency action plan. The law also required every athlete, coach, parent, volunteer and school nurse to annually review and sign a concussion information sheet.
A player who has concussion symptoms, for example, cannot return to practice or competition until he is cleared to play by a physician.
Kevin Reiley, Roses certified athletic trainer, sees the desire to play almost every time he evaluates an athlete who may have sustained a concussion.
Most of them have been evaluated before or have at least seen someone else be evaluated, Reiley said. Their first reaction is to give you what they think are the right answers. Their head doesnt hurt. Everything is fine.
One point of emphasis from the NCHSAA meetings in 2008 was the need to have a licensed athletic trainer at every high school. The University of North Carolinas Dr. Kevin Guskiewicz, a leading traumatic brain injury expert, said schools without certified athletic trainers should consider not fielding athletic teams until the school had one.
Certified athletic trainers often are the first professional medical profession to evaluate a brain injury. Last year, 110 of the N.C. High School Athletic Associations 356 football-playing schools employed certified athletic trainers, according to the N.C. Athletic Trainers Association.
Another 100 NCHSAA schools had access to certified athletic trainers who were supplied by hospital systems, clinics, doctor practices or other medical groups. Coverage varied and some of the trainers were available only at football games.
First responders, who are trained in first aid but who are not medical professionals, were used at 146 schools.
The National Athletic Trainers Association said only 42 percent of high schools nationally have access to a certified athletic trainer. That means that more than 4 million of the 7.7 million boys and girls who participated in interscholastic sports in the United States in 2010-11 went the entire year without meeting a certified athletic trainer.
Even for certified athletic trainers, knowing when a player is injured and when the player can return to activity safely is difficult to determine.
Reiley conducts preseason baseline cognitive tests on the Rose football players. The baseline tests, which have been widely used in North Carolina since 2008, show the athletes brain function before an injury. If an athlete is injured, the athlete takes the test again and the results of the two tests are compared.
Balance tests before an injury and after also can give clues on recovery.
Changes on the field
Roses commitment goes beyond medical personnel.
Lipe said his team plays just as hard, hits just as hard as it ever did. But he has cut back on the hitting in practice.
We dont want a lot of helmet-to-helmet hitting in practice, he said.
Football practice is a little bit different at many schools throughout the state. Recent studies indicate that some high school football players receive more than 1,000 subconcussive blows to the head during a season. More research is needed to evaluate the accumulative effect of the hits.
Sanderson coach Tony Lewis also has reduced the amount of hitting in practice. He abelieves players are more aware of the dangers of hitting incorrectly.
Technique has not changed much in the last several years, but the emphasis on what can happen when tackling incorrectly has picked up, Lewis said. There are going to be violent collisions no matter what, but I do thinks kid are learning how to play with better technique overall.