Concussions done right: North Kitsap High School

Certified athletic trainer Chris Franklin is proud of the fact that at his high school in Washington State there were more concussions sustained in the pool than on the football field.

That's right, last year five swimmers suffered concussions but only three football players did. Too modest to admit it, he and his team are the reason why.

Great player education, superb training throughout his program and a hefty dose of care combine to make it work.

Sports medicine program

Since 1992, the North Kitsap High School Athletic Medicine program has been educating students on sports medicine topics and treating injured student-athletes.

Each year about 150 students enroll in three levels of Athletic Medicine classes, some are athletes, others want to pursue a career in the medical field after high school.

These students often spend time after school providing first aid coverage for the athletic teams at North Kitsap. Not only does the Athletic Medicine program provide a well-rounded curriculum to teach students about injury recognition, treatment, prevention, first aid/CPR, anatomy, physiology, and principles of conditioning, they also educate administrators, coaches, parents, and student-athletes on sports-related injuries and how to recognize and prevent them, especially when dealing with concussions.

One of the many strengths of the North Kitsap High School Athletic Medicine program is their concussion recognition/management program. For the past 14 years, they have had two certified athletic trainers (ATCs) on staff overseeing care for more than 600 student-athletes. Between the two, they provide sports medicine and rehabilitative coverage after school, at sporting events and all practices. In addition, they continually focus on proper concussion management and return-to-play guidelines.

Baseline testing

An important aspect of the concussion policy at North Kitsap, is computerized neurocognitive testing of ALL student-athletes, regardless of sport. This is done every two years through the ImPACT concussion testing program. Baseline testing is important in the management of concussion recovery and return-to-play decision for any athlete.

Equipment

Even though all concussions cannot be prevented, Chris Franklin has minimized the number that occur in his school district. Seventeen years ago when he arrived at North Kitsap, he implemented a policy where the night before each football game, he or the assistant athletic trainer refit the entire football team’s helmets. A former collegiate football player, Franklin realized that football players lose weight through their face after the initial helmet fitting during training camp and that football helmets’ air bladders tend to lose their air throughout the season. He believes that a correctly fitted helmet will reduce the chance of a football player receiving a concussion. Recent research proves this to be true.

Procedure

When a student-athlete is suspected of having suffered a concussion they are first evaluated by the ATC. Franklin or his assitant call the student’s parents and give them the head injury information sheet (Figure 1) that explains the dos and don’ts of a concussion and what to do if symptoms worsen. Teachers, administrators, counselors, and the school nurse are made aware of the injury, the effects it could have on the student in class and to set up a health plan for that student. Each day, the injured student-athlete is expected to check in with the ATC who tracks the student's recovery and keeps the school, coaches, and administrators up to date on their progress.

Figure 1

Not only is the prevention and recognition of concussions important, but how they handle the return to play following a concussion is critical as well. Using guidelines similar to the 3^rd International Conference on Concussions in Sports (Zurich, 2008), one of the ATCs will have each concussed athlete go through the following return-to-play criteria:

a. No physical activity; rest until asymptomatic

b. Light aerobic exercise once the student-athlete has passed the neurocognitive testing (ImPACT Software), along with a licensed medical doctor’s clearance and once student-athlete is asymptomatic. Light aerobic exercise must be supervised by the Certified Athletic Trainer and must follow the following schedule.

i. Day One: Increase in heart rate for 20 minutes (Stationary bike, etc.). If symptoms occur, stop immediately.

ii. Day Two: No symptoms from Day One, increase in heart rate for 30 minutes (Elliptical, [non-contact drills]). If symptoms occur stop immediately.

iii. Day Three: No symptoms from Day Two, practice in NON-CONTACT drills (conditioning, shooting, etc.) If symptoms occur, stop immediately.

iv. Day Four: No symptoms from Day Three, practice in non-contact drills, one on one drills. If symptoms occur, stop immediately.

v. Day Five: No symptoms from Day Four, Practice in full contact and non-contact drills. If symptoms occur, stop immediately.

vi. Day Six: No symptoms from Day Five, Practice normally. If symptoms occur, stop immediately.

vii. Day Seven: No Symptoms from Day Six, return to game play.

c. Any recurrence of concussive symptoms should lead to the athlete dropping back to the beginning.

The ATCs take the student-athlete through the drills, staying in constant communication with the parents and coaches to let them know how the student-athlete is progressing.

Since 1992, the North Kitsap High School’s Athletic Medicine program has provided extraordinary sports medicine care for their student-athletes, particularly when it comes to concussion management. From the education of the students in the Athletic Medicine classes to their efforts to minimize the occurance of concussions, the number of injuries are relatively low compared to the national average.

This high level of care for the student-athletes is attributed to the level of support that the school administration along with the district administration has shown in employing two certified athletic trainers at North Kitsap High School for the past 14 years.

Questions/comments? Contact Jean Rickerson at This e-mail address is being protected from spambots. You need JavaScript enabled to view it.