From pro football on down, everyone involved with the game is worried about concussions.
But in the Marysville and Arlington school districts a Concussion Baseline Testing program is being used to try to be even more accurate in determining if one has occurred.
The three football teams in those towns have a pre-test this month. Their reaction time is tested, kind of like a field sobriety test. A computer program comes up with a baseline score. Players are then tested during the season – especially if they get a hard knock – and the numbers are compared.
"They can tell me or a doc I'm OK, but they can't get by the reaction test," said Tim McTee, athletic trainer at Marysville-Getchell High School. "They lose their balance or memory because their neurons can't get fuel. They're done for the day, and we tell their parents."
McTee said concussions can be hard to spot, unless the player is knocked unconscious.
"It can look like normal contact," he said.
Last year, Arlington also implemented base-line testing to screen for concussions. For all sports, athletes must take a test that measures their maximum mental faculty, head football coach Greg Dailer said.
McTee said the baseline numbers should help prevent serious concussions by detecting them when they first happen.
"The second hit is the one that causes massive swelling in the brain, the helicopters to land, being put in an ambulance, and the kid not saying anything," McTee said. "That's the one we can prevent" by having them sit out after the first one.
Smaller schools like Lakewood don't have the option of using baseline numbers.
"We don't have a full athletic trainer in our district, so we can't do brain scans," head coach Dan Teeter said. "But we've been trained to look out for symptoms."
Marysville-Pilchuck Athletic Director Greg Erickson said the district is "ahead of the game" and goes "above and beyond" to protect its athletes.
Players must sign a registration form before playing any sport that says they will follow protocol when such an injury may have occurred.
Football helmets purchased are top of the line at $379 each. Helmets have a 10-year lifespan, but the district ones are reconditioned every year anyway at the high school level, and every other year for middle school players.
"We have the best equipment available," Erickson said. "But even with four-star helmets, there's no guarantee a player won't get a concussion."
Lakewood High School is buying top equipment too, the Riddell Revolution Speed helmets.
"We are buying top-of-the-line helmets for our players," Teeter said.
Improvement in helmets and even as minuscule equipment such as mouthpieces have decreased the risk of concussions.
But proper use of equipment is just as crucial.
"Read the use of the helmet on the back," Dailer said. "Don't use the helmet as a weapon."
Coaches often change the way they coach for various reasons. But because of the increasing concern over concussions coaches now teach players to tackle with their shoulders and wrap with their arms, rather than lead with their head. Spearing or leading with a helmet is a severe penalty.
"Officials are getting better watching for it," Erickson said.
Another adjustment to fighting concussions is changes in tackling techniques, such as the "gator-roll" tackle. Described as an effective but safe form of tackling, the gator-roll emphasizes the tackler wrapping up the ball-carrier's legs and then rolling to the ground, Teeter said.
"The runner can't go anywhere without his legs," he said.
Concussions occur most obviously in football, but they happen in other sports, too: basketball, volleyball, soccer — even golf and diving last year.
Erickson said players are looked after in high school, but he's not so sure about the junior high level.
"It's the middle level I worry about," he said, regarding concussions. "Their dads want them to keep playing, and they go out and buy their own helmets. But they need to error on the side of caution."
MARYSVILLE SCHOOL DISTRICT RULES
Concussions: Caused by a bump, blow or jolt to the head. All are potentially serious and may result in complications, including prolonged brain damage and death if not recognized and managed properly. You can't see a concussion and most occur without loss of consciousness. Players often don't report them, but that makes them vulnerable to great injury. A second one can cause severe brain swelling and devastating consequences. It is better to miss one game than an entire season. When in doubt, the athlete sits out.
Concussion signs: headaches, lightheaded, light sensitivity, noise sensitivity, irritability, emotional, poor concentration, dizziness, loss of appetite, trouble sleeping, academic problems, balance problems, feeling "in a fog," nausea. Symptoms can last for minutes, hours or days.
Call 9-1-1 or go to emergency room: vomiting, vision loss, slurred speech, numbness in limbs, increasing headache.
State law: Requires a licensed health care provider trained in the evaluation and management of concussions to clear a player — not a coach or parent.
6 steps to return: Don't return day of injury; at least 24 hours for each step. 1, no activity. 2, Light aerobic exercise. 3. Sport specific exercise. 4. Non-contact training. 5. Full contact with a signed note from a doctor. 6. Cleared to play next contest if other steps completed symptom-free.
• A report in the May 2014 American Journal of Sports Medicine says concussions in high school have doubled from 2005 to 2012. Researchers said that does not mean sports are more dangerous, just that awareness has increased. Many concussions still go undiagnosed. Four sports have seen a significant increase: Football, wrestling, baseball and girls softball, although soccer still has the highest rate among female sports. The report also says that in 2007 50 percent of players were noncompliant in reporting concussions, compared with 20 percent in 2013, most likely because of increasing awareness of how dangerous a second concussion can be.
• Another study says four of 10 concussions still go unreported. Reasons include: not knowing it's a concussion, not thinking it's serious, don't want to leave game and don't want to let down team.
• Still another study says helmets only reduce injuries by 20 percent. The report, published in the America Academy of Neurology, says 330 test dummies were used with 10 popular brands of helmets. The Adams A2000 was the best, and the Schutt Air Advantage the worst in their testing, with the Riddell 360 also ranking high. In a different study, by Virginia Tech, the Riddell 360 was ranked first.