MCPS Football ParentsQuestions to Ask at Tonights Meeting With Coaches High school football begins today at public high

schools in Montgomery County, Maryland. My son played JV at MCPSs Walt Whitman High School and during his sophomore year, 2011-2012, sustained a serious concussion. Managing his recovery over the last 2 years, I have come to learn that high school football was a lot more dangerous than I thought. I have also learned, though, that high school football in Montgomery County is a lot more dangerous than in surrounding school systems. The biggest issue is a weak sports safety culture that runs throughout the MCPS high school athletics program. In the course of trying to get MCPS to improve its concussion policy, I kept running into other sports safety issues where it is an outlier. MCPS has brought its policies in closer line with best practices in surrounding school systems, but it was only after repeated reminders and advocacy. And significant safety issues and a weak safety culture seem to remain. Below are questions about three areas that I would ask tonight if I had a son playing football at an MCPS high school: athletic trainers; heat stroke risk; and reducing concussions and repetitive head trauma.

Athletic Trainers at Your High School? Sports safety experts say if a school system cant afford an athletic trainer, it cant afford to have a high school sports program. Many surrounding school systems have had athletic trainers at each high school for years. In fact, the Fairfax County, Virginia school system has two full time athletic trainers at each high school.1 Last month, MCPS indicated that 7 high schools would get part time athletic trainers who will serve 20-25 hours per week for the 2013-2014 school year. (Four other high schools will share two athletic trainers.)2

1 http://www.scribd.com/doc/159976982/Map-of-Md-and-Northern-VA-Counties-Status-With- Athletic-Trainers-08-13-2013 2 http://www.scribd.com/doc/159561150/MCPS-Md-Athletic-Trainer-Pilot-Program-for-11-of-25-HighSchools-See-Item-M-on-p-3

The seven schools getting part time athletic trainers are Blake, Walter Johnson, Kennedy, Magruder, Northwood, Sherwood, and Whitman. The four schools sharing two athletic trainers are: Churchill, Einstein, Richard Montgomery, and Rockville.3 If your high school is not one of the seven, ask your coach tonight when your school will be getting one. If you are one of the four high schools that will be sharing two athletic trainers, ask when your school will be getting its own athletic trainer like the seven other high schools do. Heat Stroke Management Heat stroke is a serious and potential fatal condition where the bodys core temperature rises above a safe level. In high school sports, the majority of heat stroke cases happen in football. How many happen in MCPS we dont know because MCPS does not keep such statistics. In MCPSs informal annual survey of football coaches, they did not report any heat illness cases in 2010 or 2011. Neighboring Howard County, however, keeps detailed records of all sports injuries and reported 22 and 14 heat illness cases in football in 2010 and 2011.4 Howard County only has 12 high schools so for MCPS, with 25 high schools, a fair estimate is double that, or 28 to 44 heat illness in football per season. Four years ago, Edwin Dek Miller, a student at MCPSs Northwest High School, died of heat stroke in a no-pads football practice. Its the Heat Index, not the AQI Index MCPSs policy for managing heat stroke, however, remains flawed in at least two ways. Heat illness risk doesnt just correspond to the outside temperature. Rather, it depends on both temperature and relative humidity, which is measured by what is called the heat index. As you can see at the heat index chart at this footnote, dangerous conditions can exist with the outside temperature as low as 85 degrees if the relative humidity level is high enough.5 And the heat index has to be measured at the field of practice or play because it can be influenced nearby heat islands, like a parking lot or a school roof. Sometimes the field 3 http://www.scribd.com/doc/159943124/MCPS-Md-Athletic-Trainers-at-11-of-25-High-Schools-
2013-2014-the-Haves-and-Have-Nots
4 http://www.scribd.com/doc/121864839/Howard-County-Maryland-Public-Schools-Report-of-

Injuries-in-High-School-Sports-Program-2006-2011
5 http://www.scribd.com/doc/154595381/Heat-Index-Chart-Tenn-High-School-Athletics-Ass-n

itself can be heat island if it is an artificial turf field where temperatures can soar. So you cant just look at the heat index for a region. An athletic trainer is trained to measure the heat index before every practice or game using a device called a psychrometer. And the athletic trainer records the reading on a log chart like this one: http://www.scribd.com/doc/159612075/HS-Athletics-Heat-indexDaily-Log-Template MCPS Athletics heat policy, however, never considers the heat index. Instead, coaches and athletic directors are instructed to consult the air quality index readings for the particulates and ozone in the region.6 The danger of making heat activity restriction decisions based on the air quality index readings instead of heat index readings was on display during the heat wave that the DC area experienced between July 12 and July 19 this year. On many of those days, the heat index was above a level for which any outside activity was safe. The air quality indices for those days, however, did not exceed a level that under MCPSs policy would have resulted in any restriction on activity. So MCPS needs to change its policy to align with best practices. And it needs to go out and buy 25 digital psychrometers and keep them properly calibrated. If I were a parent with a kid playing football in MCPS, I might just buy my one and do my own reading at the field. Emergency Plan for Heat Illness When a heat illness emergency happens, seconds count. The gold standard practice is to have a shaded cooling station, water, and ice and a tub that a student suffering from heat stroke can be immersed up to his or her shoulders.7 Cool first, then transfer. A distant second best is to pack ice under a students armpits and groin and transfer to the school shower. Its a second best because the delay in getting the student immersed in ice water could reduce the changes of the student surviving a heat emergency. MCPS Athletics heat policy allows a school to chose which of the two responses and at least one high school.8 Whitman, has chosen to go with the second best plan.9 6 http://www.scribd.com/doc/159563031/MCPS-Athletics-Weather-and-Heat-Guidelines-July-2013 ; http://www.scribd.com/doc/159562932/MCPS-Athletics-Heat-Restrictions-July-2013 7 http://ksi.uconn.edu/emergency-conditions/heat-illnesses/exertional-heat-stroke/ ;
http://www.momsteam.com/health-safety/hydration-safety/ice-water-immersion-best-treating- exertional-heat-stroke ; 8 http://www.scribd.com/doc/159562675/MCPS-Fall-Sports-Heat-Illness-Plan-July-2013

So ask your coach tonight what is his emergency heat illness plan. Also ask if he has ever practiced it in a timed drill. Concussion/Repetitive Head Trauma Studies show football consistently accounts for half of all concussions in a high school sports program. Equally concerning are studies where high school football teams were equipped with helmet sensors that showed that each player sustain between 650 to 1,000 blows to the head in a season. And the number of times the brain gets jostled is likely higher because such sensors dont pick up when the head gets whiplashed from a blow to the body. So the emerging theory about concussions in football is that, while one can occur from a single big hit to the head, it is the repetitive subconcussive blows to the head that can cause symptoms.10 Scientists at Purdue University released a report in February 2012 of a study that had followed a high school football team for two seasons. Each players helmet was outfitted with an accelerometer to measure impacts and each players brain was given a functional MRI (fMRI) of his brain doing certain tasks both at the beginning of the season and at the end. The Purdue Studys results show that even players who had not been identified as having sustained a concussion showed altered brain function on their fMRIs from the beginning of the season to the end. And it took months for the brain function to return to normal. The implications of the Purdue and other studies for gradual return to play procedures is that, were fMRI available, it would likely show in some cases that a student who had successfully complete the five stages without symptoms returning still had altered brain function. Long term, NFL players have been diagnosed with chronic traumatic encephalopathy (CTE), an Alzheimers-like condition that resulted in the suicide of Junior Seau and other players. CTE has been diagnosed in the brain of a college player, Owen Thomas, who committed suicide. Limits on Full Contact Football Practice In response to these concerns, the NFL limits full contact practice to 1 per week during the season. In 2011, the Ivy League adopted a limit of 2 full contact football practices per week, not waiting for a consensus from the NCAA, which is still thinking about it. 9 http://www.scribd.com/doc/155922379/Heat-Stroke-Emergency-Plan-Walt-Whitman-High- School-Bethesda-Maryland-July-2013 10 http://www.purdue.edu/newsroom/research/2012/120202NaumanFootball.html 4

In May 2012, I called on Supt. Starr and the Board of Education to adopt similar limits. I was disappointed when Supt. Starr wrote them defending the status quo of 3 full contact practices per week. http://www.scribd.com/doc/120923128/06-01-2012-Memo-FromMCPS-Md-Supt-Starr-to-Bd-of-Ed-Re-Concussion-Issues At the January meeting for parents interested in football, one MCPS football coach told parents that he was aware of the research showing 650 to 1,000 repetitive blows to the head in high school football, so in response, he was limiting full contact practice to only 3 per week. I was disappointed by this because it sounded like the MCPS football coaches had decided to stand their ground and not change, but present the status quo as if it were change. Its different elsewhere in Maryland. Just across the boarder in Howard County, a year ago they adopted the two practice per week limit. One coach, Kyle Schmitt, only did one full contact practice per week.11 The Baltimore Sun wrote: Kyle Schmitt, the coach at Atholton High School, has an even more conservative approach to training and only has his kids wear full gear once a week. "We limit hitting. We just don't beat our kids up," he said. "We stress the mental portion of the game rather than knocking heads." Coach Schmitt recently moved to Archbishop Spalding High School. I reached out to him and asked whether he was going to follow a similar conservative practice. No change, he said. We are more interested in practicing smart not fast. Maryland State Department of Education Task Force The Maryland State Board of Education Concussion Task Force recommendations for State Board action regarding limits on full contact practices. http://www.scribd.com/doc/160017707/Md-State-Dept-of-Ed-Recommendations- for-Limiting-Full-Contact-FB-practices-in-season-to-2-per-week-08-13-2013 The Task Force recommended: A team may conduct full padded practice days, but may only participate in live hitting drills and live game simulations with live hitting no more than two practice days per week. Live hitting drills or live game simulations with live hitting shall not be conducted the day prior to a game. 11 http://www.baltimoresun.com/news/maryland/education/bs-md-concussions- 20120912,0,3746070.story 5

Last month, MCPS updated its concussion policy and the new policy, on page 6 of 9, includes the two full-contact practice limit but it is listed as a recommendation. http://www.scribd.com/doc/159960048/MCPS-Md-High-School-Athletics- Concussion-Plan-July-2013 So tonight, you may want to ask your coach whether he will follow the two full contact practice limit this coming season. Better yet, will he follow Coach Schmitt and only do one full contact practice per week.