Concussions in football: The moment of impact

Updated: August 19, 2011 7:51PM

Annie Gonzalez doesn’t strike you as the type to stand up to a fire-breathing, sideline-stomping football coach. She’s a genial sort with a big smile and a quick laugh.

But on Friday nights, she has a job to do. And you’d darn well better let her do it.

“I was working a football game in Fort Wayne,” Gonzalez recalls. “A kid had taken a hard hit, and the coach said he was going back into the game, that he was fine to play. But he clearly wasn’t. So he yelled and screamed and said he was going in, anyway. So I just took the kid’s helmet away and he was done for the night. They can hate me all they want, I’m not going to risk a kid’s safety in any way.”

Meet the last line of defense on the football field, the true strong safeties — the athletic trainers.

On Friday nights — and at just about every other high school sporting event — these medical professionals have veto power over all players, coaches, school administrators, referees, even parents.

They decide when a kid is too hurt to play, not the coaches. And most coaches are quite grateful for that relatively recent fact of football life.

“I like that I don’t have to make decisions about injuries,” Valparaiso coach Mark Hoffman says. “We have a medical staff that makes those decisions. I don’t want to get involved with that.”

Or as Wheeler coach Dan Klimczak puts it: “What an athletic trainer says is law. Any coach who doesn’t defer to an athletic trainer is slicing his own throat and putting his credibility and career in jeopardy.”

It hasn’t always been that way, of course. In a what-have-you-done-for-me-now business defined only by wins and losses, coaches weren’t always so receptive to someone taking key players off the field.

Mark Leto has been Hobart’s athletic trainer since 1992. During a Monday night JV game, a player suffered a head injury. When he showed up for school on Tuesday, he was in bad shape — “real vacant, real vague,” Leto says. This was back in the early 1990s, long before concussions became the hot topic in sports, and long before medical professionals had much research and experience in dealing with them.

But Leto played it safe, and held the kid out of practice that Tuesday. When he held him out again on Wednesday, the coach blew up.

“We got into a little scuffle,” Leto says. “I said I didn’t feel comfortable letting him go, and the coach got angry. I mentioned a possible concussion, and he said, ‘Those things don’t happen.’ Well, yeah, they do.”

The kid in question woke up Thursday, promptly passed out and was rushed to the hospital.

“That night, the coach comes up to me, just he and I, and he says, ‘You saved my ass,’” Leto recalls. “And I said, ‘No, we saved each other’s ass. It’s not me vs. you. I’m a Hobart guy, I went to school here and I want you guys to win as much as anybody. But big picture, we want these kids to be functioning adults, and there are things that just aren’t worth it.”

So Leto and his fellow athletic trainers look for tell-tale signs of concussions in the wake of big hits. If a kid is slow to get up, if a kid staggers back into the huddle, if a kid has slurred speech or confusion or headaches — the athletic trainer will pull him from the field and give him a quick examination.

One commonly used tactic to is tell an injured player three random words, then ask a few other questions, then ask the player to recall those three words.

“If they can’t remember them after just a minute or two, there’s probably something wrong,” Leto says.

Then it’s usually off to the hospital.

In an age of growing awareness of head injuries and the risks high school athletes face — and with athletes bigger, stronger and faster than ever — athletic trainers have become welcome fixtures on the sidelines on Friday nights.

Many of the bigger and wealthier schools have full-time athletic trainers on staff. Others pick up trainers from outside sources — Gonzalez, for example, is contracted out by Select Physical Therapy and works just about every Boone Grove sporting event throughout the school year, and even teaches an introduction to athletic training class at the high school.

Bernie Stento, who has been working at Chesterton for 17 years — the last 12 as a full-time athletic trainer — estimates that “slightly more than half” of Indiana schools have full-time athletic trainers. For comparison’s sake, he says Michigan has about 30 percent.

He’d like to see it become mandatory, cost be damned.

“If you’re willing to provide interscholastic sports at the high school level, there’s a certain duty you owe the provide them with proper medical care,” he says.

While IHSAA commissioner Bobby Cox said the state governing body hasn’t mandated athletic trainers because of the great expense, very few sporting events — particularly football games — are held without one. Even cash-strapped schools such as the three Gary public schools have athletic trainers provided by the city school corporation.

Longtime Gary athletic trainer Dr. James Dye even visits the teams on a regular basis during the week, and often sees injured kids at his office at Sport Orthopedic Rehab in Gary.

“They provide an athletic trainer everywhere we play,” said Lew Wallace football coach Al Williams. “The Gary School Corporation’s always been good about that.”

Of course, even the rich schools don’t have as many athletic trainers as they have teams, so their attention is almost always divided. Varsity football is always the top priority, taking precedence over any other sport. But if a varsity soccer game coincides with a JV football game at the same school, the athletic trainer likely is at the soccer game, but is on call to run over to the football field if an injury occurs. (Some nights, the athletic trainers log more miles than the track team, racing back and forth between events.)

Soccer has the second highest incident rate for concussions — largely because of headers and the risk of colliding with another player’s head — with girls basketball a surprising third.

“They fall down a lot,” Gonzalez explains.

The IHSAA has granted referees the same authority to remove a player from the field if the official has reason to suspect a concussion. Before last season, referees only had that power if a player was rendered unconscious for any amount of time — putting referees without any medical training to determine such a thing in a precarious position. Now, any player who’s slow to get up, or staggering around, can be sent to the sidelines by the officials to be checked on by the athletic trainer. But most of the time after a big hit, the athletic trainer is already out there in a flash.

If there isn’t a medical professional on hand, the official’s word is final.

“They err much more on the side of caution these days, which is good,” longtime official Bob Parker says. “It’s not a big deal, because if we have to stop the game for an injury, the kid has to go for a play, anyhow.”

And as athletic trainers have become more and more common at the athletic complex, in the locker rooms and in the classroom — and more and more a part of the team, working alongside the players every step of the way from the start of two-a-days to the end of the season — those heated run-ins between coaches and athletic trainers have become far less common.

After all, they’re all on the same side.

“I’m just trying to get these kids out of high school,” Gonzalez says. “I want the kids at my school to be able to eat their own food later in life and not have to eat through a straw. Because if it was my child, I wouldn’t want him sent back out there with a head injury. So I treat them all that way.”

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