Head injury rules up for vote

But who would pay for trainers?

A recommendation that every North Carolina high school have a certified athletic trainer to handle concussions may face a tough vote today because of questions about who would pay for it.

A task force on concussions appointed by the N.C. High School Athletic Association gave the plan to the association board on Tuesday. The total cost of having a trainer at each of the association's 381 schools is estimated to be $18 million; many systems already have trainers in place.

After the meeting, Bobby Guthrie, the Wake County Schools athletics director and an association board member, said some superintendents are worried that the association might require schools to have the trainers without money available for their salaries.

"Some of the superintendents were concerned about mandating a position without funding it," Guthrie said.

The association, whose full board is expected to vote on the recommendations this afternoon, appointed the task force after the deaths of two North Carolina high school football players in the past several months caused by traumatic brain injuries.

"Everyone wants to have certified trainers in each school, but several board members question whether the association can mandate it," said Charlie Adams, the executive director of the association. "Can the association tell Cumberland County Schools or Wake County Schools how to spend funds?"

UNC's Kevin Guskiewicz, a concussion expert, presented the task force's recommendations Tuesday. The group recommended that:

* Athletes who have a concussion not be allowed to play until they are cleared by a physician.

* Athletes in sports such as football, lacrosse and soccer have baseline assessments done before the start of the season as an aid in evaluating students who later have concussions. The athletes would take tests such standing on one leg. Observers would count physical corrections such as swaying during a set period. A concussed athlete would have to approach the score he received before the injury.

* A concussion education program be developed for coaches and athletic trainers.

The lack of certified trainers at some schools was highlighted when Jaquan Waller of Greenville's J.H. Rose High School died in a game in September. Earlier, Matt Gfeller of Winston-Salem's Reynolds High School died from head injuries suffered in a game in August. Chapel Hill's Atlas Fraley also died following a practice in August, but the cause of his death has not been announced.

Waller had been injured in practice two days before the game and was examined by the school's "first responder."

Rose does not have a certified athletic trainer and, like many schools, relied on what the district termed an "injury management specialist" to evaluate Waller. Certified athletic trainers must meet qualifications that include training, education, and ties to a supervising physician. First responders typically have less training and meet far less stringent requirements.

Concussion guidelines

Most concussion guidelines used by licensed athletic trainers call for an athlete to be symptom-free at least a week before being allowed, with a physician's consent, to practice or play again. In October, Beverly Reep, the Pitt County school superintendent, said the district would try to hire a licensed athletic trainer for each of its six public high schools and expressed hope that the state would help.

State Rep. Douglas Yongue, a Democrat representing Hoke, Robeson and Scotland counties, said at the time that it was possible the state legislature could take up the issue of funding trainers. Yongue, chairman of the appropriations committee, said in October the issue "is worth taking a look at" but that coming up with the money would be tough.

The News & Observer reported in June that the athletic association has a net worth of at least $18 million, including an $11.5 million endowment that it isn't allowed to spend. When asked about using the money to fund trainers, Adams said in October that it was not an option. "It is not the responsibility of the association to fund athletic trainers or other people in the schools," said Adams, whose organization runs conferences and state championships.

About half of North Carolina's public high schools employ certified athletic trainers, compared with first responders, who have been trained primarily in cardiopulmonary resuscitation and first aid. In Wake County, 20 of 21 high schools use licensed trainers.