Sen. Richard Sears '69, D-Bennington, remembers what it was like to "get his bell rung" as a football player at the University of Vermont in the late 1960s. Back then players dealt with what is regarded today as a concussion by "shaking it off" or taking a brief trip to the sidelines for some smelling salts.
“You just kept playing because you didn’t want to look weak, but I’m sure most players back then had at least two or three concussions,” says Sears, who still coaches high school football.
As the debilitating effects of concussions became more widely recognized with former NFL players being diagnosed with chronic traumatic encephalopathy, Sears became concerned with the safety of high school football players in Vermont. After seeing players remain in games despite sustaining concussions, he decided it was time to address the issue legislatively. “I could see that they had a concussion, but there were no athletic trainers at some games, so I began to put together legislation that included certain protocols and safety measures.”
Sears contacted a handful of concussion experts including Alan Maynard, clinical associate professor of Rehabilitation and Movement Science, who brought a rare mix of expertise to the process as director of UVM’s Athletic Training Program and president of the Vermont Association of Athletic Trainers. He’s also a practicing clinician as athletic trainer at Bellows Free Academy in Fairfax. Maynard provided key testimony to legislators and helped craft what would become one of the most comprehensive concussion laws in the nation.
“Alan’s role was critical,” Sears says. “I don’t know if it would have passed without him.”
New law one of most comprehensive in nation
The majority of the new law, Senate Bill S.4, went into effect in July of 2013 with a key provision requiring all schools in the state that sponsor collision sports (football, hockey, lacross and wrestling) to have a healthcare professional trained in concussion management at every home game to become law in July of 2015. Currently, only 14 schools have fulltime athletic trainers while less than half of the the rest have part-time trainers or no concussion coverage at all. Some legislators considered the bill an unfunded mandate due to the cost of athletic trainers, but a feasibility study by Maynard resulted in some converts. He found that only nine schools would be financially affected by the legislation with the highest impact to any one school being $2,310 annually. Overall, the cost of covering all previously uncovered events was estimated at $10,500.
A compromise was eventually struck allowing schools to have someone trained in concussion protocol, which incudes an online training course on the Center for Disease Control website. “It can be difficult for rural schools to pay for athletic trainers, but this is at least a step in the right direction, and players will definitely be safer because of it,” says Maynard.
Maynard says the previous law, which required minimal education about concussions, the removal of a concussed player from a game, and a note from a doctor clearing them to return to play, wasn’t strong enough. For starters, it’s unlikely a player is going to be removed from a game by a coach, especially if there is no one trained to recognize the symptoms in the first place. “There’s too much of an ulterior motive to put these decisions in the hands of coaches who want to win and likely have little to know medical training,” says Maynard. “You also don’t want to rely on the student-athlete to make these decisions, especially if they are concussed and want to play no matter what.”
Another flaw in the prior law was that it didn’t address the power given to healthcare providers -- some of whom are not trained in concussion protocol -- who have final say over when an athlete can return to play. Some athletes and parents go "fishing" for doctors who will write pre-mature return-to-play notes, says Maynard. “These are generally the people who write the scripts for return when a school doesn’t have an athletic trainer. It puts the athlete and the school at incredible risk.”
The new bill attempts to address this issue by equipping family practice providers and pediatricians with the latest return-to-play guidelines distributed by The University of Vermont Medical Center. “We’re not there yet, but the new law should increase education across the board,” Maynard says. “If we can get information about return-to-play into the heads of pediatricians and other healthcare providers who make these decisions, that’s a win.”
Another addition to the law requires schools to have a concussion management plan -- guidelines for what to do when a concussion happens and what has to happen before the athlete's return -- for collision sports. “It definitely makes student-athletes safer, maybe even as much as the sideline coverage mandate. Most states have laws with the three components in our old law, but not this part, which makes it one of the most comprehensive in the country.”
Creating a culture of safety
Maynard was working as an athletic trainer for BFA-Fairfax at the 2014 Div. III state football championship when a player sustained a hard helmet-to-helmet hit. It wasn’t easy, but Maynard had to tell the coach to take the player off the field for the rest of the game. “No one wants to hear that, especially a senior playing in a state title game that is probably the last game of his career, but no one questioned it when I said he had to come out.”
Creating a culture that places safety over winning takes time, says Maynard, but the two don't have to be at odds. Case in point: BFA-Fairfax captured the school’s first-ever state championship this year. Part of that culture change involves altering the perception of what constitutes a concussion and the terminology that surrounds it. Being “dinged” after a major hit, for example, sounds far less dramatic than calling a concussion by its actual definition: a traumatic brain injury.
“Safety doesn’t create weakness,” Maynard says. “Having an athletic trainer saying you can’t play doesn’t mean that you are a weaker person, it just means we’re helping you make a better decision. The coaches at BFA-Fairfax understand that they have been entrusted by parents to make good decisions for their children in a sport that is very gladiator. They take that responsibility very seriously and try to ensure that there is a culture of safety throughout all athletics.”