The Missouri State High School Activities Association's most recent report on head injuries suggests high schools' sports and activities communities are being more proactive about monitoring student-athletes' health.
MSHSAA's Executive Director Kerwin Urhahn presented the 2016-17 annual report on head injuries Wednesday to the Legislature's Joint Committee on Education.
State law has mandated since 2011 that MSHSAA "publish and distribute an annual report regarding the impact of student athlete concussions and head injuries which should include efforts that may be made to minimize damages from school sports injuries," according to the report's introduction.
"Football has been number one every year that we've done this survey," Urhahn said of the sport that has the most reported head injuries — once again the case in 2016-17. For girls, soccer sees the most reported concussions, followed by sideline cheerleading; these three sports or activities reported the most head injuries last year.
The survey Urhahn referenced was sent to 590 grades nine-12 high schools and combined grades seven-12 schools; 503 responded.
The survey asks schools to report details like the total number of participants in various sports and activities; how many reported concussions there were per sport or activity; whether those reported injuries were directly-related to participation; how many class and activity days were missed on account of a suspected injury; how many diagnoses were made; and whether schools have emergency action plans or utilize ambulances or athletic trainers.
The numbers from MSHSAA's latest report show actual head injuries in football have declined a little more than 11 percent since 2012-13.
At the same time, participation in 11-player football has declined a little more than 8 percent — down to 20,926 players statewide — and the rate of reports of suspected concussions in 11-player football increased more than 56 percent for every 10,000 athletic exposures. Athletic exposure is calculated by multiplying the days of practice and competition by the number of participants.
Other numbers associated with head injuries in football fluctuated year to year, and they don't seem to be tied to the level of participation. As participation has fallen, the number of suspected head injuries has remained stable, between 1,260-1,404. There were 1,325 suspected sport-related concussions in 11-player football last year.
The number of activity days missed in football on account of sport-related concussions increased almost 28 percent — 17,838 collective days last year — but the number of class days missed has decreased about 2 percent to 1,421 last year.
Concussions are the bruises on the brain caused by impact with the inside of the skull. "There is nothing we can do to ensure they're all going to be 100 percent safe and no concussions ever occur. There's not a piece of equipment that you can put between your brain and your skull," Urhahn said.
He said MSHSAA is working to prevent more devastating injuries that can result and offering guidance for helping students with suspected head injuries adjust upon returning to the classroom.
"Where we find the most damage, from what our research shows, it's not the initial concussion that's the dangerous one, it's the second injury syndrome," he said, meaning athletes who suffer one concussion are "at greater risk for greater injuries" if they take another blow to the head.
"If you think that the kid is displaying symptoms (of a concussion), take them out of the game," he added.
"What we tell our schools is they need to set in policy who's responsible for making the determination on return to play," he said. The professional making that evaluation could be an athletic trainer, doctor, physician's assistant or nurse practitioner.
He added whoever that person determining return to play is, their word must supercede even the written consent of other medical professionals parents might seek. He cited a wrestler whose parents sought a second medical opinion and got a doctor to sign off on returning to play, but their child was prevented from returning anyway.
"Were (the parents) upset with us? Absolutely. But I will tell you, after a couple weeks, when they thought about what could have happened to their child, they actually wrote us a letter and thanked us for not allowing them to go back out and wrestle," he said.
"We are also in the process right now of working with our sports' medicine advisory committee to develop some recommendations for what we call 'Return to Learn,'" because, as Urhahn elaborated, concussions are invisible injuries. MSHSAA is hoping to provide teachers some guidance on how to adjust to students with suspected head injuries returning to classrooms, given "part of the issue you have with concussions is being able to focus and listen to what's being said."
He said MSHSAA also encourages schools to have emergency action plans in place that can help save the lives of staff, officials and fans as much as players — keeping in mind it might have to be students enacting a plan if a supervising adult has a medical issue.
To that end, Urhahn added, "through the help of the National Federation (of High School Activities) foundation, (MSHSAA's) going to supply any high school that reported to us they did not have an AED in their school, we're going to provide them an AED for free."
An AED is an automatic external defibrillator.