Close to Home: Injury shows ongoing risks of football

The tragic injury to a Fortuna High School player at a game at Cardinal Newman High School on ?Aug. 25 is every football parent’s worst nightmare (“Fortuna football player suffered stroke,” Tuesday).

For those on the sideline medical team, it may be the worst night of a career.

Football is an inherently dangerous collision sport with a risk of head injury that is more than twice that of other contact sports, such as soccer or lacrosse. This commentary is not an indictment of the sport or a call for its ban. It is important, however, for us to consider what we can do to make it as safe as possible, particularly around head injuries. Innovations in helmet design, custom mouth guards, neck strengthening and changes in tackling technique (such as “heads up” or “rugby tackling”) have yielded disappointing results when studied critically. To date, there is no protective device, technique or medicinal supplement that can prevent concussions.

The most successful approach to decreasing concussion rates is simply limiting exposure to risk, i.e. less tackling and hitting. “No-hit” leagues in youth hockey are a model. Practice rules changes in Maryland high school football led to a ?50 percent decrease in concussion injuries. The California Interscholastic Federation adopted similar rules limiting full-contact practices last year.

Education about concussion recognition and treatment is also important. For the last four years, North Coast Concussion Management, a nonprofit organization, has provided concussion education and resources to our local high school athletes, coaches and physicians in the community. We were instrumental in developing and launching computerized concussion testing in the five Santa Rosa high schools.

Our most important function, though, is supporting the certified athletic trainers in our city schools.

While we don’t publicly know the details of Blake Foley’s injury, early reports are ?consistent with second-?impact syndrome, a devastating brain injury that occurs when an athlete suffers a second blow to the head before an initial injury is fully healed. Recognition of the first injury and avoiding the second is the only prevention.

While second-impact syndrome is an extremely rare event, we have long recognized the risk of repeat and more severe concussions by returning to play too soon. Recent studies have shown that closely repeated minor head injuries can be more dangerous to long-term brain health and development than more significant, but infrequent, injuries. This window of risk for compounding injury varies in length for a given athlete and is hard to predict. Having someone present consistently, who is familiar with the athlete, is the best current measure of that time frame of when it is safe to return to play.

Certified athletic trainers provide an important presence on the sideline and practice field. Studies have shown a much higher recognition rate of concussion injury when a certified athletic trainer is present. Coaches are simply, and appropriately, more focused on the game. Certified trainers are also excellent first responders, as demonstrated on ?Aug. 25 when Cardinal Newman’s recently hired full-time athletic trainer was a crucial member of the medical staff, coordinating care with the emergency response team.

These individuals are trained to recognize and respond to multiple aspects of sports medicine, including sudden cardiac collapse, heat illness and musculoskeletal injuries. They perform a crucial function in managing recovery and return to play; coordinating care between athlete, school and treating physician.

There was a certified athletic trainer on the Cardinal Newman sideline but not on Fortuna’s. Whether that would have made a difference is impossible to know, but we can say that our student athletes are safer overall with them present.

We applaud the decision of the Santa Rosa City Schools District to fund the presence of certified athletic trainers at all five high schools. We recognize the budgetary constraints and challenges in our public schools. Marin County, however, committed to this idea and now has a certified trainer at every school in the county, funded through a variety of mechanisms. We call on all Sonoma County school boards and the parent community to make this a priority as well.

Dr. Ty Affleck is medical director of Santa Rosa Sports and Family Medicine in Santa Rosa. Dr. Robert Nied is a physician with Kaiser Permanente Family and Sports Medicine in Santa Rosa. Both have special training in concussion care and are on the board of North Coast Concussion Management.

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