This is the second in a two-part series on concussions in Vermont school sports.
By ANNA GREARSON
Of the 48 Vermont high schools that offer collision sports — football, hockey, wrestling and boys lacrosse, as listed by the American Academy of Pediatrics — 14 do not currently have any athletic training coverage and only 13 have full-time staff.
According to Senate Bill No. 4, or S.4, currently sitting in the House Education Committee awaiting word on movement to the full House of Representatives, schools “shall ensure that a health care provider is present at any athletic event in which a high school athletic team participates in a collision sport.”
That clause has become the elephant in the room for the state’s athletic training officials and the vast majority of athletic directors who are left wondering what will happen should the bill pass and adequate coverage under the new law has still not been found.
“It will severely impact our athletic program,” said Oxbow athletic director Rich Thornton.
According to a spreadsheet provided by South Burlington athletic trainer Denise Alosa, who is also on the Vermont Principals’ Association sports medicine advisory committee, the schools that offer collision sports but do not have athletic training coverage are Bellows Falls, Enosburg, Hartford, Missiquoi, Northfield, Otter Valley, Oxbow, Poultney, Putney, Randolph, Richford, Sharon, Springfield and Windsor.
The bill — which wouldn’t take effect until July 1, 2014 if passed — requires medical professionals at collision-sport games to be trained in concussion management within the last five years.
“I know a lot of schools use EMTs, and they’re fine to cover events for the big, bad stuff, but they don’t have concussion training nor are they able to clear concussions,” said Alosa, who’s been on the South Burlington sidelines for 15 years. “It’s a double-edged sword.”
Oxbow offers football, which is currently covered by an ambulance service as well as a parent who is a registered nurse and has taken it upon herself to study concussions and football-related injuries.
“But according to that new law, that won’t work,” Thornton said.
For Division-I Spaulding, which employs a full-time athletic trainer, the debate is where to send the athletic trainer and when to schedule games.
“If we have two events, let’s say a football game and soccer — and we play soccer off site — and soccer is deemed to be one of these collision sports — it would put (athletic trainer) Jason (Carriveau) and I in a position to map out what we need to cover to be in compliance with the law,” Spaulding athletic director Pat Merriam said. “Now we prioritize in our best estimation the spots he needs to cover.”
While no one has expressed a disinterest in having such coverage, the cost has been prohibitive — “substantially huge,” according to Merriam — for many Vermont schools.
“To get even a part-timer, it’d be $10,000 minimum, but we’re looking at upwards of double that in all likelihood,” Thornton said. “I’ve researched this extensively, and it’s a challenge in itself to get one to come to our school.”
Bradford lies just outside of the Dartmouth-Hitchcock coverage zone, and the nearest hospital is Cottage Hospital a dozen miles away.
“I don’t think (supporters of S.4) have taken into account how this impacts all the schools in a state like Vermont, especially the schools that are rural,” Thornton said.
The governing body of Vermont high school athletics, the Vermont Principals’ Association, currently requires football and boys and girls hockey to have medical coverage present. That coverage could mean EMTs or athletic trainers. Some schools, like Spaulding, provide both at hockey and football.
“You have to have immediate access (to appropriate medical facilities),” said Bob Johnson, the VPA’s associate executive director who is in charge of all school sports and activities.
“There can be full-time, part-time coverage with athletic trainers who work alongside physical therapists in a rehab clinic, home-only coverage on a contract or per diem basis,” president of the Vermont Association of Athletic Trainers Alan Maynard said. “There’s such a wide array of what it could look like.”
Maynard argued that hiring an athletic trainer would ultimately cut costs for both schools and parents.
“What an athletic trainer provides is risk reduction for the school,” he said. “You have someone who is trained and has expertise working with physically active folks who are likely to be hurt. They provide immediate care in an emergency setting and are able to talk to parents and coaches rather than rush off to the emergency room or go in an ambulance when it’s not necessary.
“We don’t need to send every concussion to the ER, that standard of practice is outdated. If you have someone trained... you can avoid a lot of these other costs out-of-pocket, and reduce risk. It’s a win-win.”
Neither the current legislation nor the proposed bill outline consequences for not complying.
“The way I interpret the law, if they don’t have coverage, the game gets cancelled,” Johnson said. “I don’t see any way around it. If there’s no medical coverage and somebody gets hurt, they’ve opened themselves up to a huge liability issue.
“No one is opposed to safety for the kids. But when you start legislating it, and people haven’t thought about unintended consequences... I have concerns about legislating medical practice.”
Alosa is concerned the bill, called “an act relating to concussions and school athletic activities,” limits the focus when mandating medical coverage.
“I think they’re missing the bigger picture with other health issues that could need an athletic trainer,” she said. “Cardiac arrest can happen in all ages, heat illness kills 10-15 high school athletes a year, and there’s internal and spinal cord injuries. It’s important that when we start to look at coverage guidelines that we look at who’s covering.
“We need to be careful about mandating these things and the false sense of security of having the wrong person there.”
Others have expressed concern that the introduction of and attention surrounding S.4 has not let the current legislation, Act 058 passed in 2012, have a chance to work.
“I think there are some good parts to (S.4), but I also think the bill we have is working okay,” Alosa said.
“We do have a law on the books that works pretty well,” Maynard said. “This is an attempt to clean it up a little bit and it adds coverage.”
Supporters of S.4 say the current legislation was “premature.”
“With the NFL highlighting this, I think it’s a matter of time before there’s a federal concussion law,” Montpelier football coach John Murphy said. “I thought (the legislature) should’ve done more research. As a result, they push a law into effect and now there are some issues. I see in my experience where it needs to be changed to identify who is liable and who can clear at the appropriate time to return to play.”
The new bill also requires each school to develop an action plan for concussion management, similar to the Recognize, Remove, Refer, Return plan passed in Oregon under Max’s Law in 2011, which has drawn tremendous support.
“It’s a critical component,” Maynard said.
The underlying issue in student-athlete safety is communication. Maynard, who is also the athletic trainer at BFA-Fairfax, described a “culture of safety” that starts with the individual coaches.
“Coaches have to be the drivers of a culture of safety, they must be,” he said. “To me, the incidents with athletes hiding concussions, that might be relatively isolated. I’ve talked to other athletic trainers, and it’s not something we see.”
At Montpelier, which had a student admit he hid concussion symptoms in order to keep playing, the athletic trainer reviewed the school’s procedure, based on the Fletcher Allen Health Care Concussion Task Force protocol that many schools utilize, with parents and players in pre-season meetings.
“Some kids, unfortunately, are unable to make those meetings,” Montpelier athletic director Matt Link said in an email.
“It’s nice that people are standing up and paying attention to a lot of these issues,” Alosa said. “It’s unfortunate we can’t get every school to make it a priority, dollars-and-cents-wise.”
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