Article by Darren Dahl
This article originally appeared in the July/August 2015 Net Assets magazine.
When the state of Florida mandated in March that female high school lacrosse players must wear helmets, an outcry ensued. Critics questioned why protective headgear would be required for a sport that doesn’t allow contact. The short answer: the risk of concussions.
The kids playing football hated me because their helmets were tighter on their heads. But we stopped having as many concussions.
Laura Richins
Porter-Gaud School
Concussions, or mild traumatic brain injuries (TBIs), have been in the news for some time in the wake of injuries suffered by professional football players and subsequent lawsuits against the National Football League. In April, the NFL agreed to a class-action settlement providing up to $5 million per retired player for serious medical conditions associated with repeated head trauma.
But TBI incidents as a whole have been on the increase. In the U.S. from 2001 to 2009, the most recent period for which data is available, the number of TBI-related visits to emergency rooms for people 19 or younger increased from 153,375 to 248,418, according to the CDC. Bicycling, football, playground activities, basketball and soccer were associated with the greatest number of these visits. As concussions and awareness continue to grow, independent schools are increasingly implementing plans to prevent concussions from happening; educate coaches, staff, faculty and students to recognize them when they do occur; and support the process necessary to a healthy recovery.
Concussion threats are something John Wallace, director of finance and support services at Porter-Gaud School in Charleston, South Carolina, constantly faces, as his school’s 902 students participate in some 62 active sports teams.
“We have to take the issue of concussions very seriously,” said Wallace. “These children are entrusted to our care. We need to minimize the risk of them getting injured and then be proactive when something does occur.”
He’s had a lot of help in that regard from Laura Richins, the school’s athletic trainer. Richins said that in her first year at Porter-Gaud four years ago, there were 35 reported sports-related concussions. During the 2014–15 academic year, by developing a formal training and response protocol that helps coaches and athletes avoid common causes of head injuries such as ill-fitting equipment and full-contact drills, the school had a total of only three sports concussions.
“The kids playing football hated me because their helmets were tighter on their heads,” said Richins. “But we stopped having as many concussions.”
An Ounce of Prevention
There’s a simple reason that concussions and other injuries suffered by student athletes are a hot topic with independent K–12 schools: They are a major source of liability claims brought against schools, said Joe Vossen, associate risk management counsel at United Educators (UE), which provides liability insurance and risk management services to schools. “We will never eliminate injuries or claims in general. But schools can take steps to protect themselves and their students.”
A study conducted by UE in conjunction with NBOA, Risks and Risk Management at Independent Schools, found that athletics represented the largest source of general liability claims against schools, with soccer generating the most claims.
An obvious way schools can reduce their exposure to student injuries is to create the best possible conditions to minimize the chances of injuries happening in the first place.
In United Educators’ 2003–2012 K–12 Athletics Claim Study, UE looked at athletic injury claims at K–12 schools over a 10-year period and found three main culprits:
- Defects in facilities or equipment
- Inadequate supervision
- Poor medical response and treatment
To help address these factors, Vossen suggested schools ask three questions:
- Are our facilities and equipment safe? Do they meet local standards and manufacturers’ guidelines?
- Who is supervising our student athletes? Are they certified for supervising that particular activity?
- When an injury does occur, what steps will we take to get students healthy and back into the classroom?
“A broad lesson is to make sure that everyone at the institution — including teachers, support staff, medical staff, athletic trainers and coaches — knows the school’s policies on how to keep students safe during athletic practice and competitions and how to spot injuries after they occur,”
said Vossen.
The key is to have written policies in place and to ensure that faculty, staff and coaches are all educated on what they need to do to keep that child safe.
Cheryl McDowell
Bolton & Company
When it comes to creating those policies, schools also need to think beyond the athletic fields, said Cheryl McDowell, vice president of the Risk Management, Education Practice Group at Bolton & Company. “Schools also have to recognize when an injury occurs regardless of how or where it does,” she said. “It might be a child falling off the monkey bars or getting kicked in the head while swimming. The key is to have written policies in place and to ensure that faculty, staff and coaches are all educated on what they need to do to keep that child safe.”
Written policies should also cover topics such as hot weather and when it’s unsafe for students to be practicing outside. Clear rules should designate the number of certified lifeguards, not just coaches, that need to be on hand when students are using the school’s pool, for example.
Michael Dorn is executive director at Safe Havens International Inc., an organization that provides safety assessments for thousands of schools around the world. He recommends that schools also draw up diagrams in advance of events like basketball or football games, as well as for playgrounds and parking lots, that specifically map out the areas security, staff or faculty should monitor and when and what they should look for. “That helps clarify what everyone’s role is and also provides a set of documentation for the school to show who was on duty in case an accident does happen,” Dorn said.
Having qualified supervisors and certified healthcare providers on hand is important when students travel to away games and matches as well.
Another big takeaway from the second UE study relates to how schools react in the event of an injury. Vossen says that while poor medical response and treatment claims accounted for just 16 percent of all athletics claims, they accounted for more than half of athletics losses — greater than $4 million — experienced by schools during the 2003–2012 timeframe.
When Concussions Happen
While schools can help reduce the occurrence of concussions through better equipment, limiting full-contact drills and improving facility maintenance, they will still occur.
That’s where a program like Porter-Gaud’s could prove a best practice for other schools to emulate. Richins relied on resources such as the CDC’s HEADS UP initiative to help create the school’s concussion policy. She also developed specific protocols for coaches, teachers and parents to follow in the wake of an injury, as symptoms of a potential concussion might occur some time after the actual injury is sustained.
In the event that symptoms of a concussion exist, a school should have a plan to both protect the student and establish a recovery plan before he or she returns to the athletic field, said Richins. Consistent enforcement is essential.
For example, if a Porter-Gaud athlete exhibits any concussion symptoms, the school’s policy clearly states that he or she should immediately be pulled off the field and can only return when cleared by a physician with experience in treating head trauma. Richins admitted that she has had to push back against coaches, students and even parents to keep students off the field — though that kind of resistance has become more rare as the consequences of head injuries have become more widely understood.
Increasingly, it is also critical to communicate with parents even before an incident occurs. At Windward School, in Los Angeles, the concussion protocol includes sending parents a “concussion information sheet” when their child is suspected of having a concussion. Among other things, this sheet lists potential symptoms, warns of risks and requires the signature of both the student-athlete and the parent or legal guardian.
Getting the Word Out
Besides including concussion information in enrollment materials, many schools use preseason parent-coach meetings to discuss their policies. “You should revisit the policy and train people on it to ensure everyone understands all the pieces of it,” said Paul Ibsen, assistant head of school for finance and management at Providence Day School, in Charlotte, North Carolina, which has some 1,596 students. “You need to treat it like a living document.”
In addition, schools should press the issue by having parents and students sign waivers prior to the season to help ensure they are aware of the school’s policies regarding concussions. Consider The Westminster Schools in Atlanta, Georgia, where some 80 percent of 1,850 students play organized sports. There, a system provided by Magnus Health digitizes the entire waiver process. That enables the school to keep track of which parents have signed the waivers and which have not, said Wendy Barnhart, director of business and finance. She adds that Westminster uses the same waiver system for students who aren’t enrolled at the school but use its athletic facilities.
It’s worth noting, said McDowell of Bolton & Company, that while having parents sign a waiver or release form can be a great risk management tool, this practice won’t necessarily prevent a parent from suing the school. “Different language also holds up better in different states,” she said.
As part of their concussion response plans, many schools have also begun baseline-testing students prior to the season. McDowell said that while baseline testing is a relatively new practice for independent K–12 schools, she believed it will soon be considered a “best practice” in TBI management. Along these lines, some schools offer baseline testing to their entire student body.
Porter-Gaud requires baseline testing of every student who participates on an athletic team in grades 6 through 12 — or about 80 percent of the student population for those grade levels. To do this, the school employs a program called ImPACT, developed by the University of Pittsburgh Medical Center’s Sports Concussion Program. Student athletes are tested before the season on neurocognitive information such as memory, reaction times and processing speed. Should an injury occur during the season, a student can be tested again for comparison to his or her baseline.
Having that kind of information can be helpful when it comes to establishing not only when student athletes might be ready to return to the field if they suffer a concussion, but, more importantly, when they are fit to return to the classroom as well.
The Westminster Schools also has a process for addressing the question of when a student is healthy enough to resume studies or training. This January, the school formed a concussion management team led by Donna Hays, the school’s head athletic trainer, and Anna Moore, a neuropsychologist who studied traumatic brain injuries at Emory University and now teaches a neuroscience class at the school. Hays and Moore led the development of a five-stage “Return to Learn” program that provides guidance to students, parents and teachers on when students may return to school and what they may do while attending classes.
For example, some students start off by returning on a half-day basis. “Depending on the symptoms and the child's ability to tolerate school helps us determine when they are able to progress to the next stage in the return-to-learn process,” says Moore.
This process can be a challenge, admitted Barnhart. “It can be chaos getting kids back into the classroom because every kid is different and progresses differently.”
As the science around concussions evolves, it remains important for a school’s athletic department and business officer to work closely together on regularly updating the school’s concussion and injury response policies and procedures.
“It all comes down to risk management rather than risk avoidance,” said Ibsen. “It’s like having a spare tire in your car. You hope you never need it. But when you do, it’d better be there.”
