Westchester County Executive Robert P. Astorino was joined today by local, state and national experts and advocates in concussion care, as he unveiled 10 "Best Practices" to address gaps in the way sports concussions are identified and treated, with a particular focus on reducing the risks for high school athletes.
In July, Astorino created the Westchester Concussion Task Force with the goal of developing a model program for improving the outcomes for the full spectrum of sports-related concussions. The task force is made up of local doctors, educators, coaches and trainers, all with experience in concussions, some with nationally recognized expertise.
The 10 "Best Practices" have been published in a booklet called "Safer Sports: A Collaborative Response for Westchester to Sports-Related Concussions." The booklet also contains information and resources related to concussions. More information and a pdf format of the booklet is available at westchestergov.com/safer-communities.
These 10 "Best Practices" have already been endorsed by the Brain Injury Association of America and New York State.
"I grew up playing sports, my kids play sports, and I coach them, so I strongly believe in and encourage sports participation for all young people," said Astorino. "But I am equally an advocate for sports safety and education on how to best prevent and treat injuries if and when they occur."
"Concussion treatment, like all medical issues, is a complex subject. Our goal is not to scare parents; suggest we have all the answers, or to insert county government into an area where the primary responsibility rests with parents and school officials," said Astorino. "Our goal is simply to play a helpful role. One way the county can do that is to bring resources, and we have done just that with the creation of the Concussion Task for and the publication of the Safer Sports booklet. Our next step is to get the information distributed as broadly as possible."
The Safer Sports initiative was launched after a meeting between Astorino and Dr. Mark Herceg, the county's Mental Health Commissioner. Herceg explained how there were gaps in current concussion protocols at the high school and youth sports level, suggested the creation of a concussion task force, and Astorino gave him the green light.
"The more resources you can bring to a problem, the better the result," said Herceg. "We think concussion treatment will be much improved by improving the coordination, collaboration and communication on the part of everyone involved in treating an injury. "Many times parents whose children sustain concussions, either in sports or otherwise, don't know what provider to see for their symptoms. Schools and providers need to work together and that's what we are promoting."
Scott Cohen, a Scarsdale junior and concussion care advocate, was on hand Monday to support the effort. Scott sustained a concussion as a freshman football player and had lingering issues.
"Many of my teachers didn't know how to handle me as a student and I had other issues that took a while to resolve," said Cohen. "I really like this plan and feel that it would have helped me in my situation because it emphasizes a team approach, awareness, training, immediate assessments and returning to the classroom. I'm happy to endorse this plan and believe that it will help future athletes should they get injured."
Astorino said the task force will stay together and continue to explore frequency, recovery times and gender differences in concussions at the high school and youth sports level and that they would all work to encourage local schools and youth sports organizations to adopt the best practice guidelines.
The Safer Sports is the latest initiative in Astorino's Safer Communities campaign, which was launched in 2013 and emphasizes partnerships and comprehensive problem solving among all stakeholders to improve the health and safety of our communities. Previous initiatives have addressed school absenteeism, suicide prevention, youth mental health first aid, and improved protocols for handling active shooter scenarios on school campuses.
The 10 Best Practices in concussion management at the high school and youth sports level recommended by the Safer Communities initiative are:
Start with Awareness
1. Formally educate parents, students, athletes, coaches, appropriate school personnel and youth sports programs about concussions and school protocols before participating in sports.
Build a Team
2. Encourage schools and youth sports organizations to have a designated concussion management team (CMT) that brings together experts trained in concussions. The team should meet or communicates regularly. At minimum, the CMT should include, but not be limited to, an athletic trainer, physician, nurse, athletic director and school/neuropsychologist.
Report What You Know
3. Ensure that all concussions are reported along with any lasting symptoms from the field or playground, to parent, to ER, to health professional, to the classroom. Concussions do not just happen in a game; they can happen in gym class or at recess.
Assess Situation Immediately
4. Utilize athletic trainers and conduct sideline assessments that can be compared to baseline behavior, in order to capture concussions in real time as they occur.
Don't "One-Stop" Shop for Answers
5. Districts and youth programs should provide referrals to specialists (neurologists, physical therapists, neuro-ophthalmologists, neuropsychologists), as needed, to treat specific symptoms. One provider should not be the "one stop shop" for all symptoms.
Understand the Big Picture
6. Ensure everyone involved understands the impact a concussion can have on behavioral, academic, emotional, and physical maturation of young children.
Stay Current
7. Health care providers evaluating children and adolescents must maintain a current level of understanding of the diagnosis, treatment, and management of sports-related concussions
Encourage Training
8. Ensure that properly trained professionals, such as athletic trainers, are available to conduct sideline tests and that the results are reviewed and interpreted by a neuropsychologist or school psychologist.
Beware of Simple Answers
9. School, youth programs, parents, and students need to be aware that concussions are a clinical diagnosis, and that it takes more than a single or brief computerized test to understand the extent of the injury.
Focus on Return-to-Learn
10. As important as return to play is for a child, it is more important that schools have a return to learn plan (RTL) to address issues children face as they return to the classroom after an injury. Returning to the classroom does not always parallel returning to play.
A full list of the members of the Westchester County Concussion Task Force is as follows:
Mark Herceg, M.D., Commissioner, Department of Community Mental Health
Sherlita Amler, M.D., Commissioner, Department of Health
Iris Pagan, PhD, Director Westchester Youth Bureau
Jay Dunkle, M.D., Neuropsychologist, White Plains
Eric Schwabe, M.D., Vestibular Therapist, NY Sports Medicine Institute
Avi Mohan, M.D., Pediatric Neurosurgeon, Westchester Medical Center
Barbara Kapetanakes, M.D., Neuropsychologist, Sleepy Hollow
Jeffrey Young, M.D., private practice, Dobbs Ferry
Katherine Hough, M.D., Pediatrics on Hudson, Hastings-on-Hudson
Jonathan Berkowitz, M.D., ER Physician, Westchester Medical Center
Ronald Jacobson, M.D., Chief of Pediatric Neurology, Maria Fareri Children's Hospital
Vikki Ionnatti, M.D., Assoc. Chief of Division of General Pediatrics, NY Medical College
Neil Roth, M.D., Orthopedic Surgeon, New York Sports Medicine Institute
Dave Byrnes, President Section I Athletic Trainers Society and Yorktown H.S. Athletic Trainer
Michael Mirabella, VP of Section I Athletic Trainers Society and White Plains Athletic Trainer
Arthur McCormack, Athletic Director, Irvington High School
Douglas Sawyer, Athletic Trainer, The Hackley School
Mike O'Donnell, Athletic Director, Stepinac High School
James Rose, Yonkers Athletic Director and Chair of Section One Safety Committee
Mike Skerritt, Director of HR, Putnam Northern Westchester BOCES
Kris Harrison, Ed.D., Superintendent, Irvington School District