Tuesday, June 18, 2013

Head Trauma Policy

For those of you who may not know, I recently lost a very good friend due to complications to a head injury he received outside of roller derby.  If you knew Percy Q-Tion, he was a very dedicated ref in the derby community, who often traveled to Virginia and North Carolina to help out with my team's games.  He was passionate about rescuing dogs and loved his son very much; I cannot say enough kind things about Percy, but this blog post isn't really about him, it's about what he happened to tragically die from.

According to national statistics, 1.7 million people a year suffer from a form of traumatic brain injury, or TBI.  30% of TBI sufferers die from their injuries.  Read that again, 30% of them die.  In the United States, the annual incidence of sports-related concussion is estimated at 300,000. Estimates regarding the likelihood of an athlete in a contact sport experiencing a concussion may be as high as 19% per season.......PER SEASON!  TBIs can be mild, or severe; mild TBIs include concussions, which has been a growing in popularity in our sport of late, especially because of the changes in the game.  Have you noticed that more collisions are happening on the track?  You can blame all of that clockwise skating going on; whenever two people collide face to face, there is a good chance that someone is going over backwards.   It's not just for newbies anymore!   Concussions are a real danger now and we as a sport have to be ready when they happen to our teammates.

I have been on my soap box about crappy helmets in derby.  Yes, if you have a "sweat saver" helmet with soft lining in it, you are courting a concussion.  I don't care if sweat savers are more comfortable, they are doing less than nothing to protect the most important thing on your body, and that is your brain.  Derby isn't forever, but brain damage can be; if you aren't using a top grade helmet, you are taking a huge risk with your brain health.  I understand that no helmet can completely protect you from brain injury, but hockey helmets, Nutcase brand helmets and helmets with the harder foam liners can help protect your brain better than fluffy liners.  I beg of you to get yourself a better helmet, NOW.  Stop making excuses.  Stop denying it... you need to protect your brain and that should be worth any cost. 

So, enough about helmet safety.  Let me move on to a second and higher soap box.  What does your league have in place if a skater hits his or her head at practice?  Do I hear crickets?  You should, as a league, have something official in place in case one of your skaters receives a TBI.  No longer is it ok for the league to leave it up to the skater to make the decision on whether they should seek medical help.  Someone suffering with a head injury cannot be trusted to make the correct medical decisions for themselves; if they have a brain injury, even a mild one, they may have impaired judgement and teammates need to step in. If your league has a procedure for head injuries your members will feel like they are backed up in any decisions needed to be made.

I think that many people have the fear that they don't know what they should do.  "What if it is just a bump on the head and I'm making a mountain out of a molehill?"  Well, I personally don't think you can screw around with any kind of head injury, but there are some of the warning signs someone is suffering from a TBI.  Here are the observable behaviors that coaches and other teammates can be aware of.

1.  The skater appears to be dazed or stunned.  People with head injuries are stunned.  They may not react quickly and appear to be "Out of it."

2.  The skater is confused about what is happening on the track.  Ha ha. I'm not talking about that jammer brain people get sometimes, but they are genuinely confused to why they are skating or on the track.

3.  The player is unsure of game, score, or opponent.  If someone seems to be suffering from a head injury, ask them what's happening.  If they can't tell you with any clarity, the chances that they have a concussion are pretty high.

4.  The skater moves clumsily.  Balance is the first thing to go in head injuries.  After Percy hit his head, he fell two more times due to the primary injury.

5.  The skater answers questions slowly.  Sometimes a person's language skills get compromised due to a head injury.  Percy was unable to communicate well after he fell; he sent me a text that was completely nonsensical and when he approached other people in person, they thought he was suffering from a stroke.  Not all symptoms will be that acute, but it can happen.

6.  The skater loses consciousness (even temporarily).  This is a gigantic red flag.

7.  The player shows behavior or personality change.  This one is a little more long term, and the league should contact the skater's family to alert them that head injuries can make people act irrationally or change their personalities.

8.  The player forgets events prior to hit (retrograde amnesia).  This can be seconds before they received the blow to the head or up to an hour. 

9.  The skater forgets events after hit (anterograde amnesia).  People suffering from a TBI may not remember what happened to them after their injury.  Whole conversations can happen, and they won't remember them. 

It's so scary to demand that someone go and see a doctor in this day and age. You don't want them to spend the money they may not have, but in the case of a head injury, the injured player needs to have his or her teammates watching her back.  It's better to overreact than it is to let someone bleed out in their brain.  Percy was alone when he had his fall, and because of that, he didn't get the help he needed as soon as he needed it.  In roller derby, we are lucky enough to have teammates who are there; be a good teammate and take care of the people in your league.


And get a fucking decent helmet.







29 comments:

  1. I agree that all leagues need to have something in place for head injuries!! I got a "borderline concussion" last year and no one seemed to care... I mean, I got attention immediately, helped off the track and given an ice pack. But that was it.

    And after practice while I was still waiting for my husband to make the 45 minute drive to pick me up and take me to the ER, every single person left. All of them.

    Because I didn't pass out, and I could count the refs fingers, no one worried about me or seemed to care.

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    1. Yes, getting the "How many fingers am I holding up" question right doesn't mean the person is ok. I hope your league changes its policies.

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  2. our league has a 2 weeks minimum off skates after concussion and only back after doctors clearance. I was knocked out in a game and yep, lost about 45mins. I was lucky i didnt have ongoing issues.

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  3. Oh and my helmet had a crack in it from the hit. Skaters should also replace their helmets after a heavy contact. I have seen soo many skaters with helmets that should be replaced. Just because your helmet doesnt have a crack, doesnt mean it is safe

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  4. Thank you for the Q. I will be sure to share this with my team!

    Sincerely,
    CroSlayHer

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  5. I don't remember anybody getting a concussion in the past couple of years, but all of a sudden three girls on my team (and my mother-in-law while walking in a park) have gotten a concussion in the past week.

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  6. Perhaps I missed it, but I'd love some links to top helmets you recommend. When I first started skating four years ago I used a snowboard/skateboard helmet with the hard almost styrofoam interior. In my first scrimmage I got back blocked and went down right on the back of my head. Everyone went on and on about how my concussion (definitely had one) was because my helmet was rubbish and how OMG GET THE TRIPLE 8. I feel very uncertain, now owning a pair of helmets I've been told were great or terrible on what to actually use.

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    1. Maimy - look for helmets that are certified to pass both the single-(high)-impact CPSC standard and the multi-(low)-impact ASTM F1492. A statement I've heard lately that "hockey helmets are always better" is not true - unless you're only dodging hockey pucks being propelled into your helmet. I recently did a search for my league and found 6 helmets that were both single- and multi-impact. Not all models in a brand are - BE SURE to look inside the helmet for the sticker(s) stating that specific one you are buying does pass both tests. The S-One Lifer (kid, & big head for other sizes), the Nutcase Crossover, Triple 8 has a multi-impact helmet, also called a 'Brainsaver' - but there are Brainsaver models that are NOT multi-impact, so be extra careful if buying this brand. Protec has two that I saw - an Ace (NOT the Ace-Skate) and a B2 (again, not the B2-skate). Basically you're looking for something that has both a hard foam like a bicycle helmet (CSPC standard) and some soft foam like the Triple-8 (ASTM standard) sweatsaver all rolled into one. And if you've got $299 to spend, the Bauer Reakt would be really sweet, as they are looking to protect against a rotational-motion impact not just a linear-impact rotation (which is how all the current testing is set up). Hope this helps!

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    2. Actually, hockey helmets aren't just about dodging pucks. Look at hockey game play and look at derby game play now. Head on head blocking, backwards falls...and you have a giant sports complex investing money into research and development of these helmets. Derby is becoming more and more like hockey, but we don't have the money behind us the way they do.

      No helmet can stop all concussions, but hockey helmets are multiple impact helmets, protect more of the head (They go lower on the back of the head which is a prime area for a TBI) and they are more adjustable than most of the helmets derby girls use. I've heard the argument for years about "hockey helmets aren't the best" but I have to say that through the research I've done over the years, I'm convinced.

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    3. Yes, there are aspects of hockey helmets that recommend them - adjustability for good fit is an excellent point. Unfortunately the standards and testing are not to a level where one could say even 'most' hockey helmets are better than 'most' skate, or bicycle or dual-certified. The testing standard for hockey helmets (ASTM F1045-07) drops from a 1-meter height; The CPSC standard is 2 meters. The good news is that there is a lot of work going on and advances are being made - including the recent appearance of dual certified (CPSC/F1492) helmets. The certification standards are seriously lagging though, so for my head if all I had to choose from (cause I didn't want to do any more reading or research) was a generic HECC hockey helmet or a generic dual-certified skate helmet, I would go with the latter. But what I'd really like to buy is a Reakt hockey helmet. :-D

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    4. I think it bears repeating, NEVER, EVER, EVER buy or accept a USED helmet. NEVER. They may have invisible stresses and cracks that will not stand up under even slight pressure. Standard gear policy... Safety equipment goes from the rack, to the athlete, then directly to the TRASH. Don't donate it to the Goodwill, and don't buy it there.

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  7. Maimy, take a look at the nutcase helmets http://nutcasehelmets.com/ - they are rated on multiple assessments, and fit you better. I love mine.

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  8. From what I've heard,- head concussions are cause by the sudden deceleration of the head. You don't need to have blacked out to have a concussion.

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    1. You can get a TBI in many ways. Helmets can't stop them all, but they can stop the initial damage.

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  9. First, I'm saddened by the death of your friend and wish you and all who loved him peace and healing in what I know is an incredibly hard time. I lost one of my best friends last year unexpectedly (he was 42) and still miss him every day. My heart goes out to anyone going through that same pain.

    And secondly, thanks so much for the helmet and brain injury info. I'm still putting together my skates and gear after coming to my first 3 open practices and borrowing gear, so this post came at a perfect time form. Now I have solid information to help me buy the right helmet to protect my brain, hopefully before we get back to Thursday practices in a couple of weeks. So if, at any point in writing, you thought, "If I help even one new skater pick a better helmet, my work here is done," then your work here is done. Checking out Nutcase helmets and hockey helmets online right now...

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    1. that should be "perfect time for me." Typing before the 2nd cup of coffee...never advisable.

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  10. Also, if they are dizzy, have blurry or distorted vision or vomit after a head hit, it's probably a brain injury
    There doesn't even have to be contact to the head of any kind to get a concussion. A couple weeks ago a team mate took a hard hit to the chest that whipped her head backwards, and she got a concussion from the fast change in direction, causing her brain to hit her skull.

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  11. Nausea is also a huge, red flag. If a skater feels nauseated or throws up after a hit to the head, get him or her to the hospital.

    And ALWAYS have a first aid/CPR trained person (or two) at EVERY practice. No one there? No practice. A first aid kit ain't helpful without someone who knows what he or she is doing to administer first aid. I don't care if it's newbie practice, All Stars practice, endurance, contact, no contact - there should be a trained first responder on hand. It may be a good idea to cover the cost of training for a group of high attendance skaters if you don't have many who are certified.

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  13. Yeah I got Epilepsy from a concussion playing roller derby. I wrote about it in Five on Five this past Winter. My helmet sucked. I know alot of people switching to hockey helmets since my diagnosis. I was not suprised by how many people who did not know if their helmet was single or multi impact, if the paint they used on it was decreasing the security, etc. I am lucky that it was not worse.

    It took almost 6 months of weird symptoms due to ignorance before I had my first grand mal to be diagnosed. I advocate and try to help skaters in our areas with concussion awareness and safety. There is alot I could have done different. Thaks for seeing the seriousness of this issue.

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    1. Though I am a coach now, you can also tell by my profile pic how happy I was when I got my hockey helmet to skate no contact. haha

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  14. In Washington state we have the Lystedt Law for kids. I coach junior roller derby. We are very serious about this. If we see them hit their head we do the tests - or even if we HEAR from someone or the skater tells us they hit their head, we do the tests if ANY are not clear they MUST immediately be off skates and are not back on again until they see a doctor. AT ALL. We also do base line concussion testing at Children's hospital. It shows the normal brain patterns so doctors can diagnose them better and see if they have improvement.

    I am also surprised as skaters who get multiple concussions and still skate.

    It should be taken very serious.

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  15. For everybody reconsidering helmets, as an earlier poster indicated, there is a huge difference between helmets rated for single-impact and multi-impact. And number of impacts is typically "mild" impacts. Almost every helmet I have looked at says clearly that they should be replaced after *even one* "hard" impact, even if there are no visible signs of cracks, etc.

    I currently wear a high-end hockey helmet because they are (almost) all rated for dealing with multiple mild impacts but even these can be rendered useless after one seriously hard collision.

    Don't undercut your own safety.

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  16. I got a serious concussion 1 yr after starting derby and it took me 5 months on brain rest to recover and 2 years to get back...got cleared to practice but just got told probably shouldn't play. It's a hard choice...I have 7 kids and own our own business...I need my brain! One of the issues with my concussion...part hit/part whiplash...and I didn't take it seriously! Leagues should have a no-skate rule for at least a few weeks after a concussion. I overdid it initially and still have symptoms! Don't listen to someone with a brain injury...they don't know what they're talking about!

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  17. something to add, since i just hit my head really hard today. apparantly you're not supposed to treat head injuries with ibuprofen or any anti-inflammatories. tylenol only

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  18. There's some good info on the CDC website: http://www.cdc.gov/TraumaticBrainInjury/

    I'm an athletic trainer at a high school and just to share a mantra of sorts that is used, especially at the youth level for sports and concussions. "When in doubt, sit it out." Always sound advice.

    Also, look around for local clinics that offer pre-testing. An athletic trainer/physical therapist in my area does pre-testing for concussions for only $20. And the final reminder is, you do not need to have contact to the head in order to sustain a concussion!

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  19. And if you haven't seen the Frontline program on the NFL Concussion issues and cover-up, you should. http://video.pbs.org/video/2365093675/

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