Trainers take giant leap in establishing head trauma protocol

Knees can be repaired and even replaced. Ankles, elbows and shoulders will heal.

But as veteran Hersey athletic trainer Hal Hilmer put it, "You only have one brain and you have to take care of it."

So Township High School District 214, which includes Hersey, Prospect, Buffalo Grove, Rolling Meadows, Elk Grove and Wheeling, has taken a giant step in making sure that's the case with its athletes and students.

"Head Injury Care Guidelines and Return To Play Protocol," which was designed and implemented by all of 214's athletic trainers, was adopted the district's administrators May 21. Hilmer said the district is probably one of the first in the state and possibly the country to set down an actual protocol.

They undoubtedly won't be the last.

"These guidelines define a step-by-step approach to safely return an athlete to activity as recommended by the most current research in the field," Prospect athletic trainer Matt Guth said in a release from 214.

"Dealing with head injuries is often difficult because the athlete may seem all right," Wheeling athletic trainer Rocco Tieri said in the same release. "Many schools in the area use the same procedures but do not have a policy in place.

"This new policy gives the district athletic trainers the tools to manage the care of their athletes."

It makes use of the ImPACT test (Immediate Post-Concussion Assessment and Cognitive Testing), which was developed by a pair of doctors in the early 1990s. The computer-based testing program is specifically designed for the management of sports-related concussions and has been used in recent years by schools in District 214 and others in the area.

But now, the six district schools have an official series of steps and guidelines to follow before an athlete who sustains a head injury is cleared by an athletic trainer to return to physical activity.

"We'll look at each individual incident of a concussion or head injury on its own merits," Hilmer said. "We may have some kids out three to four weeks and we may have some out a week-and-a-half or two weeks.

"It's all based on their own signs and symptoms and the test results we get from the ImPACT computer program."

Hilmer said there's no way to cheat on these tests. But they're also a vital tool since athletes who have suffered concussions will often say they feel fine when they don't.

If an athlete reports signs or symptoms of suffering a concussion, or they are observed by a coach or parent, the guidelines do not allow the athlete to return to play and requires him or her to be evaluated on site by an athletic trainer.

Other steps include calling the parents, possibly calling 911 if an athletic trainer isn't available and making sure the athlete isn't left alone and is monitored in the hours after the injury.

Before there is a return to any physical activity, the guidelines recommend as much cognitive rest as possible, which includes limits on watching TV, playing video games and text messaging.

An athlete then will take the ImPACT test 24 to 72 hours after the injury. Test scores will be compared to the athlete's baseline scores and trainers notify the coaches and parents of the athlete's status.

In another five days the athlete gets another ImPACT test. The test will continue to be given every five to 10 days until it is determined the athlete is symptom-free.

Then comes a series of physical steps, each taking 24 hours, which must be passed symptom-free. If symptoms return, the process goes back to the previous step after a minimum of 48 hours of rest.

"We're not trying to rush a child back," Hilmer said. "We're very cautious of second-impact syndrome."

Especially with how the games and the kids who play them have changed since Hilmer, Guth and Wheeling associate principal and former athletic trainer Brian Lichtenberger started nearly 30 years ago.

"One of the things we see now is the athlete is much bigger and faster and they hit a lot harder than they did back then," Hilmer said. "The likelihoods of these injuries is much greater than it was back then."

The policy will probably cause some frustration with athletes who think they feel fine but still show signs they aren't ready to return to action.

But when it comes to head injuries, history shows it's best to be safe rather than sorry.

"We all love sports and love working with the athletes," Hilmer said of his colleagues. "We want to make sure they're as safe as possible."

mmaciaszek@dailyherald.com