Plans for dealing with head injuries vary at area high schools

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COLUMBIA - To some, the sound of two football helmets smashing into each other, gets the blood pumping. Football fans may find these hard hits fun to watch, but for the people wearing the uniforms, they could become a nightmare.

Many parents worry when watching their child play sports, because there's always the possibility of an injury. One of the worst kinds of injuries in sports is brain-related. Concussions have become more and more of a problem in high school football. 

Dr. Raman Malhotra, a brain injury expert at St. Louis University offers details on what a concussion is:

"A concussion is a brain injury unlike a lot of other brain injuries that we usually don't have to define like bleeds in the brain or bruising," he said. "It's nothing we can actually see, so we know the brain's injured because it's not working properly, but on a spectrum of brain injuries it tends to be the mildest form." 

But, Malhotra said concussions can have long-term implications if not taken care of.

"If we're not managing them properly, meaning continuing to play through the injury, maybe going back to soon, then you can be left with permanent symptoms or neurological deficits," he said. "It could be thinking problems, sleep problems, mood problems, memory problems either immediately or later on in life."

The neurologist said he uses the phrase "when in doubt, sit them out" to reduce permanent brain damage. 

The Centers for Disease Control and Prevention (CDC) lists various symptoms for recognizing concussions:

  • Fuzzy or blurry vision
  • Balance problems
  • Irritability
  • Sensitivity to noise or light

According to a 2013-2014 Missouri State High School Activities Association (MSHSAA) report, those injured on the gridiron report the most head-injuries - by a long shot. 

Last year alone there were 1,512 head injuries reported, an increase of almost 200 since 2012-2013. These reports do not necessarily mean the injury was a concussion, but that the athlete was looked at by medical personnel.

The increasing numbers may have a silver lining.

"It's not being hidden anymore," said Harvey Richards, Associate Executive Director of MSHSAA who is also in charge of football. "A kid gets his head rung or 'bell rung' as they used to say, a ding, we're sitting him out now.

Richards also serves as the chairman of the sports medicine advisory committee and said reports that weren't necessarily completed in previous decades are now being filed. 

Malhotra said, "There are definitely more concussions being reported and it's not really clear if there's more concussions happening. I do think that people are taking their concussions more serious and, because of that, they're actually seeking medical care."

KOMU 8 News reached out to all of the schools we cover for Friday Night Fever to find out their individual level of preparedness to diagnose and handle injuries. 

Of the 43 schools contacted, 36 have certified athletic trainers, 40 have ambulances, 35 have both and two didn't respond to our calls/e-mails. 

Only six schools we contacted didn't have a certified athletic trainer on the sidelines, but those schools did have some sort of medical personnel.

The map below shows the emergency responders available at mid-Missouri area high school football games. The high schools marked in green have both a certified trainer and an ambulance, the schools marked in blue have an ambulance only, the school in purple only has a certified trainer and the schools in orange did not respond to KOMU 8 News. Click on your school to see more details.

Eldon and Fayette are two of the few schools that use area doctors instead of trainers to look at their players.

Some smaller schools, like Harrisburg High School, a school of a little more than 160 students and 30 football players, cite money as a reason for not having an ambulance. 

But even schools without a trainer and an ambulance have a plan on how to handle injuries. 

Harrisburg Activities Director Doug Fessler said if the certified athletic trainer needs further assistance, "they'll call over to our EMT that's around and they'll come out to assist in that." 

He also said there are defibrillator right inside the school.

"That's the biggest thing is make sure you have a plan in place - everybody knows what they're supposed to do and when they're supposed to do it," Fessler said. 

"We want to make sure they put emergency action plans in place," the MSHSAA executive said. "We have to make sure they know what's happening if a kid does get hurt or suspected of a head injury they gotta take him out."

Richards said there is a return-to-play protocol that involves a physician's evaluation. 

MSHSAA said not all schools may be able to afford every preventative method, but there should always be a plan for on-field conduct. 

Missouri mandates all coaches and staff take a concussion signs and symptoms course before the start of every season. MSHSAA requires all athletic staff to take a CPR/defibrillator course. 

Some schools, however, are fortunate enough to have a certified trainer, ambulance, and even a doctor on the sidelines. 

Smith-Cotton Athletic Director Rob Davis said, "We take as many precautions as we have, but, unfortunately, in a sport like football, those things are gonna happen to a degree. We try to train our coaches and our trainers and people that are first responders at an event like that to be prepared to handle something like that."

Davis and Smith-Cotton have a Pettis County ambulance at home games, but if there's ever an emergency elsewhere it may need to leave. He said there are always first responders if necessary, but it's only happened once or twice during his 12-year tenure as athletic director.

 Smith-Cotton Head Coach Ryan Boyer said, "We stress technique all the time. We always say you have to see it to hit it. You have to have your head up or else neck injuries, concussions, things like that, and we always, always stress that."

Smith-Cotton's trainer, Bryan Smith, said there are a few key questions he asks players after a possible head injury. 

"I usually go tell one of the coaches that 'hey I'm pulling this kid aside' just to talk to him and see how he's feeling," he said. "I usually don't ask him any crazy questions other than do you know where you are, score, city, time of day, it just kinda depends."

Smith said he checks to make sure they injured player is doing okay mentally.

Helmets, shoulder pads, mouth guards and other equipment is supposed to reduce injury, but they don't always have the intended effect.

"Whenever you give somebody a lot of very good protective equipment, often it gives you a sense of invincibility," said Dr. Aaron Gray, a sports medicine and family medicine doctor at MU. "If you have the best state-of-the-line helmet, then you feel like you can't get hurt by it and sometimes you'll be more likely to lead with your head and potentially put your head and your brain at an increased risk."

Gray said helmets prevent skull fractures but not necessarily brain injuries. 

He also said it's not just the trainer's and coaches' responsibility to be proactive when treating concussions. 

"It's everybody's responsibility - so coaches need to know the signs and symptoms, the players themselves need to know that and they need to be able to know if their teammates are maybe not acting normal or confused," he said. "Parents need to be aware of it too."

"I think it takes kinda the whole community and everybody involved and who cares for these kids to pay attention to this," he said.

The Brain Injury Association of Missouri will be hosting an event in early February titled - Sports Concussions: Facts, Fallacies, and New Frontiers, which will be held at the Stoney Creek Inn in Columbia. 

Both paid and volunteer coaches of all sports at all competitive levels will be in attendance as well as certified trainers, athletic directors and other school administrators. 

(Hanna Yates, KOMU 8 Researcher, contributed to this report.)