Football coaches are control freaks, especially when it comes to their players. Dealing with concussions, though, is something they don't mind deferring to medical professionals.
Starting this season, football coaches have no choice. Texas House Bill 2038 requires each public high school to establish a concussion oversight team, comprised of at least one physician and at least one of the following: athletic trainer, advance practice nurse, neuropsychologist or physician assistant. They, not the coaches, will determine if a player is suffering from concussion-like symptoms. If he is, the player will be removed from play for the remainder of that game or practice.
"It's definitely going to change things," said Stamford coach Wayne Hutchinson, who kept the new state-mandated guidelines in his hip pocket for his team's Aug. 25 season-opening game. "It's going to tie the coaches' hands on putting a kid back in the game, but at the same time, it keeps kids safer. If you go through the guidelines, you will not make a bad decision on whether to play a kid or not."
The days are over when a coach returned an injured player to a game after asking how many fingers he was holding up, what day of the week it was or what team they were playing.
"When they used to pop that (ammonia) smelling salts to bring you back when you got your bell rung ... if they see you doing that now, you're in big trouble," said Mike Jinks, head coach at Class 5A Division II state champion Cibolo Steele.
The crux of House Bill 2038 is to take the emotions out of the decision when a player is suspected of suffering a concussion. While every football coach will say he never would purposely harm a player, the decision of whether or not to return a key player who has suffered a "dinger" to an important game forces a coach into an unenviable situation.
"It's going to change the game," said Randy Matthews, program director with San Angelo Community Sports Medicine. "It's going to make it totally a medical decision, and it's probably for the better."
House Bill 2038 also requires evaluation of the athlete, the following of a five-step, return-to-play protocol and a written release by a physician or health care provider before the athlete may return to play. That increases the likelihood that, if a concussion is diagnosed during a game, the player could miss the next game as well.
Some coaches say they already had removed themselves from making decisions regarding injuries, deferring to a trainer or other medical personnel. "We've followed what the trainers and doctors have told us," Merkel coach Kieth Mullins said. "Nowadays, as coaches, we don't try to be doctors. A long time ago, coaches had to be trainers and doctors, too. But that has changed. We refer our kids to medical personnel, whether it's an ankle or a concussion.
"What this new state law did was put it down in writing where there are no ifs, ands or buts. I think it's a good thing. Especially when it's safe for a player to play, it takes the burden off the coach to make the decision."
Concussions have received more public and media attention in recent years. The NFL has toughened its stance, routinely fining players for helmetto- helmet contact and for leading with their helmets before contact.
Seventy-five former players sued the NFL in July, claiming the league hid health effects of concussions from the 1920s until 2010. Within the last five years, at least two former NFL players have committed suicide after suffering concussions during their careers and experiencing depression after their careers.
Most recently, Dave Duerson, a former Chicago Bears defensive back, committed suicide at age 50 and asked that his brain be tested for chronic traumatic encephalopathy (CTE), a degenerative disease found in people subjected to multiple concussions or head injuries.
Concussions are more difficult to diagnose because, unlike broken bones or torn ligaments, concussions can't be seen on MRI or CT scans. Some hits that cause concussions look harmless.
For decades, it was thought that to suffer a concussion, the athlete had to lose consciousness. Today, though, the medical community agrees that loss of consciousness accounts for only 10 percent of all concussions.
"An injury to the brain is like a broken leg or torn knee ligaments in that the brain needs to go through a healing process," Matthews said. "Brain injuries are highly individual. Some people recover in 4-5 days, some in six weeks and some in six months.
"We are no longer approaching these injuries from the standpoint of 'Oh, it's just a concussion.' " By having a physician or health care provider determine when the athlete may return to play, the hope is to prevent athletes from returning too soon and suffering a second concussion before the brain heals from the first one. Second concussions can cause severe or permanent damage, even death in extreme cases.
The new law came 13 years after a player at Hamilton, located 33 miles southeast of Comanche, died after suffering two concussions in back-toback games. In 1998, Hamilton linebacker Chandler Craig collapsed on the field in a game against San Saba and later died from what was diagnosed as an injury to the brain. Craig had suffered a concussion in a game the week before his fatal injury. He didn't see a doctor before returning to play, which didn't violate protocol in 1998.
"Millions of kids put on helmets and play football every year. There's a one-in-a-million chance of something like that happening, but it can happen. And it did," said Chris Wilde, the Hamilton head coach in 1998 who now is a sales representative for Athletic Supply, Inc.
Wilde, accompanied by Craig's parents, traveled to Austin in 1999 to testify before the Texas House of Representatives for establishing protocol in dealing with concussions.
"I didn't change the way I coached, but I changed the way I reacted to kids," Wilde said. "I was 26 years old in my first head coaching job. I thought life and death revolved around winning on Friday night. I learned that it didn't."
Helmets better, but not enough
"People have said to me, 'I've got a kid that's had a concussion and I need a helmet that will prevent him from getting another one,' " said Sam Mayo, a 40year Lubbock-based sales representative with helmetmaker Riddell. "I tell them there's no such helmet."
Helmets come with a warning label that includes: "No helmet can prevent serious head or neck injuries a player might receive while participating in football ..."
Ronny Flowers, CEO of Odessa-based Athletic Supply, Inc., and a 43-year sporting goods veteran, echoed Mayo's statement. "Every helmet out there is a good helmet, but there's no such thing as a concussionfree helmet. The padding and shock absorbing are so much better than before, andmosthelmetsnowwrap around and protect the jaw," Flowers said.
"A lot of people want to buy a $300 helmet and a 15cent mouthpiece. I would recommend a $200 helmet, which is just as good, and a $30 mouthpiece. A lot of concussions occur around the jaw, and a good mouthpiece absorbs a lot of the shock."
Flowers said Athletic Supply puts every new helmet through a drop test before selling it. Each helmet is dropped 11 feet on a hard rubber surface, then tested in the front, back, on top and both sides for structural problems.
Texas House Bill 675, also signed into law this year, requires helmets be retired after 16 years, and for helmets 10 years or older to be reconditioned every two years. Flowers said Athletic Supply retires all its helmets - high school and middle school - after 10 years.
Flowers also said Athletic Supply reconditions high school helmets every two years and middle school helmets every three years - regardless of the helmet's age. Athletic Supply charges $35 per helmet for reconditioning, which includes cleaning, new hardware and screws, new padding and inspections for cracks.
San Angelo native Dr. Hunt Batjer - a Chicago-based neurosurgeon and co-Chair of the NFL Committee onHead,NeckandSpine Injuries - has an issue with reconditioned helmets in high school sports because they're not all tested.
"NFL players and most NCAA players get new helmets every year. That's not the case for hundreds of thousands of high school players," Batjer said. "The reconditioned helmets are clean and they have new pads and new paint, but the shell fatigues.
"There are no testing requirements for reconditioned helmets. Manufacturers say they don't have the resources to do it. It's a hole youth football players fall into."
Flowers said Athletic Supply applies the 11-foot drop test to 2 percent of each school's reconditioned helmets. "It's time prohibitive and cost prohibitive to test all the reconditioned helmets. It takes about two hours to test one helmet, and the machine we use for the test costs $35,000. I haven't broken it down for what the test costs per helmet," Flowers said.
"If we recondition a school's helmets and one fails the test, then we'll test them all. We'd have to find out what's wrong. But they just don't fail the test."
How rural schools will assemble concussion teams
Assembling a concussion oversight team won't be a problem in Abilene, San Angelo, Midland or Odessa. Licensed athletic trainers and physicians are plentiful in the major cities of West Texas.
Sports medicine facilities send licensed athletic trainers to games at smaller towns within reasonable driving distances. These trainers could join a local physician to form the concussion oversight team.
But what about small schools in remote areas? House Bill 2038 allows in extreme cases for school administrators or coaches to be on the concussion oversight team, provided they complete no less than two hours of training on dealing with concussions. At Aspermont, 60 miles northwest of Abilene, fourth-year head coach Larry Reid has the luxury of the community's local clinic and physician. Beyond that, Reid said Aspermont will have to train others to be part of its concussion team.
"We're unique to small towns in that we still have a clinic," Reid said. "We'll have a physician at all our home games, and he's the primary care physician for most of our players. Besides him, we're going to have to getsomecoachesandschool administrators trained to cover the legalities.
"I'm sure we'll use help from the EMTs, especially at road games. They'll be the people with the most experience in dealing with concussions. At a lot of real small schools, the committee is going to have to involve some of the coaches and administrators. We're going to get a majority of our coaches trained."
EMTs are Emergency Medical Technicians, or ambulance technicians, trained to assess the patient's condition, perform emergency procedures and stabilize a patient until he/she can be transferred for advanced medical care.
"We're still working on our plan, but we have a couple of EMTs from Coleman come to our games. We'll probably use them," said longtime Panther Creek coach Mitch Lee, whose six-man school is 80 miles south of Abilene. "We don't have a trainer or a team doctor at our games."
Blackwell, located 55 miles southwest of Abilene, also planned to use help from EMTs. "Luckily, we have an agreement with Community Medical Center in San Angelo. They have a trainer at all our games - home and away," said Blackwell coach Nathan Hayes. "I don't know who's going to be on the team with the trainer. We do have an EMT at all our home games."