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Concussions: All must use heads to prevent lasting injury

Former Central Valley soccer player Joseph Guerrinha suffered a severe concussion during a match in 2011. (Colin Mulvany)
Former Central Valley soccer player Joseph Guerrinha suffered a severe concussion during a match in 2011. (Colin Mulvany)

Joseph Guerrinha doesn’t remember anyone talking to him about the dangers of concussion in his sport. Since soccer is played with the feet, he supposes, people don’t make the connection.

And then, on March 23, 2011, the risks became abundantly clear.

In the season-opening soccer game at University High, Guerrinha, an All-Greater Spokane League forward for Central Valley, went up near the sideline to win a header against a U-Hi defender. But instead of striking the ball, the players struck heads. Guerrinha landed first, face down, and the defender landed on top of him.

“They went down and Joseph hit his head again on the ground – he probably hit his head two or three times,” CV coach Andres Monrroy said afterward. “That is the worst thing I’ve seen as a head coach.”

It was a heartbreaking collision, and it only worsened as Guerrinha remained motionless. It was four minutes before he regained consciousness. Paramedics arrived and immobilized him, fearing the possibility of a neck or spine injury, and transported him to Providence Sacred Heart Medical Center.

Two years later, Guerrinha is fully recovered with no ill effects. At the insistence of Sacred Heart medical professionals who treated him, he did not play again until his brain was fully healed. The Washington Interscholastic Activities Association (WIAA) and high school officials want to make certain that any athlete suffering a concussion does the same – Washington state law requires it.

“I still don’t remember it,” he said recently. “I remember waking up in the ambulance and having the paramedic giving me a series of numbers and asking me to remember them. After a few minutes, he asked me what the numbers were and I couldn’t remember.”

A number of tests were performed and Guerrinha was told to rest and stay away from the soccer pitch until he was fully healed.

“That was the big thing they told me,” he says now. “They kept stressing that it was important that I not try to get back out there and play until I was fully healed. I realize now how important that really is.”

“What we’re realizing now is that when the brain suffers a concussion, it interrupts some of the blood flow to the brain,” Spokane neurosurgeon Dr. John Demakas said. “If the brain suffers another blow before that blood flow is restored, it is much more serious because the brain already is in a vulnerable state.”

There are definite challenges involved in dealing with concussions. For starters, players don’t always report when they have concussion symptoms.

“We had a situation this year where it was a couple of teachers who came to me and told me that one of our kids wasn’t acting right,” University athletic director Ken VanSickle said. “They asked if he was an athlete and I told them that he was a football player and we put the pieces together from there.

“That’s what the system should do. We need everyone working together.”

Perhaps an even bigger challenge lies in determining who makes the diagnosis on the field.

Coaches all must pass a state-mandated test on recognizing and dealing with a concussion, and all are certified in first aid.

 “I have no problem with sitting a kid if there’s any suggestion of a concussion,” West Valley football coach Craig Whitney said. “What I’m not comfortable with is having coaches making that decision.

“I’m not saying this would happen, because every coach I know would put the health of an athlete ahead of winning a game, but coaches don’t get rehired for holding a star player out of a game. Coaches get hired and rehired for winning football games. At some level, there has to be a temptation.”

What’s more, he said, coaches have responsibilities during games. To best protect kids, it’s best to have someone looking out for them during games that isn’t distracted by the game. You need a third party whose only concern is looking out for the well-being of athletes.

Area high schools, in the Greater Spokane League and other leagues, now are working on plans to have certified athletic trainers on the sideline during games.

“We had a great program the last couple years,” Whitney said. “Rockwood Clinic provided athletic trainers for the school at no charge. Our trainer would be on the sideline with us, watching out for kids. He treated injuries, taped ankles, whatever. When it came to injuries, what he said was law: If he suspected a kid was hurt and needed to sit out, that was it. He was out of the game. I liked it and I think it worked great.”

The Rockwood Clinic, which was purchased by Community Health Systems, Inc., in 2010, announced that it would no longer be able to provide athletic trainers free of charge and opened negotiations to provide them on a contract basis.

“Well, we’ve gone corporate,” joked Demakas, whose practice is at Rockwood Clinic and who doubles as a ringside physician for amateur and professional boxing events. “It’s about profits.”

“I’m hopeful that this can all get worked out because it’s important to have trained professionals on the field,” said Dr. Eric Anderson, a sports medicine specialist at Rockwood. “I know the trainer I work with put in a lot of her own time because she was dedicated to the school program.”

School District 81 schools, as well as West Valley and East Valley all are working to find a way to keep trained professionals on the field next year, despite having limited budgets to work with.

“Monday we’re sending out an official RFI (request for information) and an RFP (request for proposal) to physical therapy clinics for the five Spokane School District 81 high schools,” GSL coordinator Herb Rotchford said. “Each of those five high schools will make their own arrangements. Central Valley and University have their own arrangements and so do Mead High and Mt. Spokane.”

Rotchford said the league is committed to having certified athletic trainers on the field for all high school sports.

“Parents trust us to take care of their kids,” he said. “The bottom line is that we’re not going to have coaches make these kinds of decisions. We want trained, certified professionals making those calls.”

Rotchford, who serves as a WIAA board member, added that the state’s governing body for interscholastic sports has added new restrictions for football beginning this summer.

“The WIAA has put a restriction on the amount of contact players will be allowed to have during the summer and fall,” he said. “We want to limit the exposure to head trauma.”

Until the end of 2012, Central Valley had a volunteer trainer on staff. That trainer retired and Rockwood Clinic will provide the Bears with a trainer for the upcoming 2013-14 season free of charge.

Performance Physical Therapy provides a trainer for University free of charge and that arrangement will continue.

“Performance is part of our community and having them provide a trainer for us is important,” VanSickle said. “He’s an expert. He’s studied all the latest information on concussions and other injuries. It’s invaluable having him here.”

Cheney opted to hire a full-time athletic trainer to have on staff.

“We have a wonderful school board and school administrators,” athletics director Jim Missel explained. “They saw the need and acted to make it work.

“It works wonderfully and I wish other schools could do it this way. He’s a full-time teacher who teaches kids how to be athletic trainers. After school he’s available for all of our activities and he’s there for all of our games.”

The other major challenge to overcome involves educating the medical community on the latest information available on concussions.

“That is a big challenge,” Anderson said. “Just within the medical community at this clinic it’s been a challenge. There is an old standard for grading concussions that included, at some levels, returning to play the same day. There is a lot of new information and more coming out all the time.

“Starting in 2001 there has been a major conference on concussion every four years. The latest one was in Zurich, Switzerland, in November of last year and they revised the consensus statement on concussion in sport. I think we all have to at least be up-to-date and on the same page with that.”