An athlete’s first instinct is to play: to stay on the field, ignore the pain, and help the team win. But when there is any possibility of a concussion, the schools’ first instinct —and their mandate — is to remove the player immediately.
For the WW-P district, there is no skimming around the state’s concussion policy. The protocol, put in place five years ago when Governor Chris Christie mandated the state follow the Zurich Consensus Statement, is comprehensive — and can be vital to a young athlete’s brain health down the line.
If a player suffers a concussion during a football game, there are more than 25 tests that can be administered, says North athletic trainer Patricia Middlemiss.
“New Jersey state law for high schools and youth sports state that if they even acknowledge one symptom, they are immediately pulled out from the remainder of that day,” she says. “At the high school level we typically refer them to a physician and then we let the physician do the evaluation and take control of the concussion management.”
Middlemiss, who has been a licensed athletic trainer for 16 years, has worked at North for eight. She said the school conducts neurological, balance, and memory tests to diagnose concussions. She has athletes complete eye tracking tests, balance on one leg, and recite their class schedule for the day, both forwards and backwards.
“It’s not only testing their memory; I’m also testing sequencing, their ability to do sequencing as well,” she says.
Once the athlete is removed from a game, he or she must follow return to play sequencing. Return to play follows four steps, and the athlete is required to be symptom free after each step for 24 to 48 hours before he or she can move on.
“I tell our coaches here at North, expect once [athletes have] been diagnosed, it’s a minimum 10 to 14 days,” Middlemiss says, though it varies on a case-by-case basis.
The first step is light activity, like walking or stationary biking conducted by Middlemisss. The next step is more rigorous physical activity, like running, sprinting, and weightlifting. Step three is similar to non-contact practices.
“For football, an example would be just walking through plays,” she says. “For a wide receiver, they can run and they can catch a pass but they can’t have a defender around them to stop them.”
The next and last step is contact practices. “There are no restrictions,” she says. “We’re looking to see, can they handle the rigors of an entire practice.”
Middlemiss said the student also takes an impact test — a written assessment of cognitive abilities —during or after the return-to-play process. The new test is compared to the baseline impact test, which students athletes are required to take prior to starting practices.
“The athletic trainer at South [Bill Severson] and I, we keep an ongoing list for the coaches before practice starts. So the coaches have an idea of who is cleared to play with regards to the impact test and who has to sit out,” she says.
Middlemiss then faxes the impact tests to the athlete’s doctor, who makes the final clearance.
“New Jersey law states that a licensed physician or nurse practitioner with concussion management training is the only one who’s allowed to clear an athlete from a concussion,” Middlemiss says.
The protocol North follows now was implemented in 2011, almost a year after Christie signed the law. Eight years ago trainers began taking athletes out of games when they displayed concussion symptoms. Before that, Middlemiss says, the district left concussion management up to the doctors.
“It was all very dependent on the physicians,” Middlemiss says. “Going back 10 years, the protocol was if you had symptoms, if those symptoms went away [in] 10-15 minutes, you could return to your practice or game that day.”
While the schools refer students to physicians, district policy can override a physician if the physician clears an athlete before completing the return to play steps.
“From my observations over the past five to 10 years it is very frustrating to the athlete because they have that natural instinct and drive to go back into participation,” Middlemiss says. “But we have to constantly reinforce to them this is their health. You need your brain for the next 60-70 years. So we constantly have to remind them why we’re doing this and why it is so important.”
