Best practices for High School Football health. Let me introduce our panel. Cody is a High School Football player from Johnson High School in iowa. As a junior he was an allstate defensive and played only four games as a senior in 2018 in part because of a concussion. He has spoken publicly about his Mental Health struggles in an effort to raise awareness. Next to cody is jennifer real and. She is an athletic trader in the Public School system where she works at hd woodson haskell. The national set of Training Association and the district of columbia athletic association. Randy is head football coach in washington dc. They won the First Washington catholic title since 2002. He was named usa todays national coach. He was there coach in germantown maryland. Thank you for being here. Similar to what we did with the last panel, first with you randy. What is one best practice when it comes to High School Football health . Do you think it has improved . What is an area where you still think we have to have more attention on . I think i can speak more specifically to my experience as opposed to Overall High School for all. I have many colleagues but i would say as was brought up earlier, the amount of time allocated toward full contact i think is certainly changed over the years. I think also the protocol in terms of recognition of injuries and return to play with regard to head injuries as well as other injuries is more structured, more sophisticated now than it has ever been. I think relative to that, the communication between athletic trainers and coaches with regard to tournament play and schools academically i think those are areas that ive seen improvements in my experience. Do you think this means more attention . I would say continued education. Everybody overall. When it comes to the coaches and parents, just continue to have these discussions. What about you . One of the improvements is a National Dialogue although concussions and heat illness are not the answer or the only problem we have. The more we have discussions the more we have valid education and the more people we reach. Unfortunately the reasons for those discussions are tragic and should have been avoided and should not have gotten to that point. I think what we need to improve on is that it should not be a question of whether or not an athletic trainer, and im self serving, but whether or not an athletic training is a worthwhile investment or should be there. If you have to have wire new uniforms more important than having an athletic trainer . Why is a sled more important than having an athletic trainer . Even here in dc Public Schools and Initiative Just got within the last two years. It should not have taken that long. That means you were a kid back then but any thoughts of what has improved . Just putting the information out there. Really informing the players so they know what to look for and when they need to get help or when they need to help their friends. I think thats really important. I want to talk first about emergency. That is so important in really any sport, but particularly for all. Not just that you have Emergency Action plans. It has much different Emergency Action plan. What should be an Emergency Action plan and how often should it be rehearsed . The Emergency Action plan must be of any specific. They must also be sensitive to the times. What we use for an ambulance in terms of foot wall has to alter during homecoming because we have a larger crowd and parking is more of an issue. So the ambulance has direct access. Agency. Who has the keys . Are the gates functioning . I checked those before every game. I make sure every gate is functioning, no one has changed the locks, any of those things. At my high school we are two blocks off of the dc maryland line. If i dial 911 i get pg county. In my Emergency Action plan the first thing you have to do is be transferred to dc ems. The county is not trying to figure out where you are. It needs to have the location of your emergency could and. You dont want people wasting time looking for those things and looking for something not even there in existence. Who the personnel is that you are going to need to contact, if its my Athletic Director thats going to open the gate, is it available or is he going to be handling something at the ticket booth . Its an eight is the bible of what you need to know in the worst possible scenario. It needs to be cleared because those people are going to be nervous and not going to be focused on the little details. So they dont have to put thought into it and they can just go down the line. We practice once a season. Your coaching changes, your Coaching Staff changes, any changes that come about. If you get a new coach it needs to be rehearsed. Everyone needs to know what their role is. Can they pretend theres a real emergency . Absolutely. Sometimes i will tell coaches and sometimes i wont. Sometimes i will tell a kid to fake an injury but the first couple of minutes they didnt know that so i need to know they are going to respond. Some coaches dont have handle deformed body now. Some dont handle blood well. Those are not the coaches that you need. You need the coach that would help you with crowd control. The coach thats going to keep the team away. The coach thats going to be levelheaded and direct them to do what you need them to do. Whats your approach . I think she had on something thats really important under a pressure situation. Or, the word is catastrophic certainly something that is not in your normal every day practice or game situation coming up with a severe injury. I think its important from a High School Coaches perspective to maintain a certain sense of poise because a lot of the people and the environment will react based on how you react. I think the athletic trainers are aware of that as well. Everyone is looking to those people for guidance and leadership. I think something as simple in those leadership positions getting poised and taking the right steps to make sure you go through what is necessary to solve whatever the problem may be. Where do you keep your emergency . Do you have tips about whats the best place and that the most number of people could possibly see that . One is going to be immediately accessible. Some trainers may to the water coolers, take them to the tables. I give my coaches a copy of the beginning of the season, wherever its going to be easily accessible and available. Emergency medical kits, or we have binders that are some of the different areas brought up or we would have our plans in case of emergency. Of course todays Technology Makes things different than it was years ago. The cell phone is certainly very helpful when it comes to the old days of trying to get to a pay phone or an office. Best practices about how to deal with that and what needs to be done and maybe one of the biggest mistakes that you see . The first mistake that people make is not cooling them first. Cooling is critical, cooling is essential. Weve had two local cases that have highlighted that more than adequately. They removed him from the cooling bath and he ended up having to have a liver transplant. Had they kept him in the tub until he got down to 100 to he probably would not have had to. He pretty much would have walked away from it. And unfortunately jordan mcnair last year had a completely different outcome and was not apparently managed as well as we would have liked for him to be. So those are things, thats all i say. Cool first cool first cool first. There are no medical conditions that you are going to worsen by cooling itself. If you are not sure, cool them and there are things that can be worsened by the delay but you have to activate ems. If its a diabetic situation. Cooling is not going to hurt the athlete but you also need to initiate proper care. Heat illness can mimic any other symptoms and conditions so when in doubt the number one way to help manage heat illness is which has been a big topic among athletic trainers. It has no come to a point like when you do cpr you are going to break ribs you assume that they will have broken ribs and live then have intact ribs and the alternative. Now we are trying to take the approach that they rather we know and not transfer them. And airconditioning ambulance is not cool enough to reduce the damage that its doing. We need to keep them on site until they get down to 102. We are trying to make that is commonplace, that we know when you got down to 102 and deal with a rectal thermometer rather than not know and not take the appropriate action. I just wanted you to share your story a little bit. You told me youve been playing football since third grade . Is that right . How many concussions have you had . Eight total concussions. Also . 4 nonsupport related and 4 football. Thats a lot. How old were you when you first were diagnosed . Just described, what are the symptoms like and did you notice . It was probably my worst concussion. As soon as i got hit i fell to the ground and blacked out. When i woke up just a few seconds later i just couldnt remember what happened. I couldnt remember really anything. That was your first one . What did you notice on another one . My other ones i started to notice less and less when i would suffer a concussion. I didnt get them actually treated until about two months ago when i actually did some for them. You were playing through it the whole time. Playing through it because you are not aware or because he wanted to keep playing . You didnt want to get off of the field . It was more so i wasnt aware and i just didnt realize because i wasnt given the right information. Finally about two months ago my mom asked me have i ever had a concussion . I thought back and realized i had a knot of a lot of them. I just played through all of them. That can be kind of common isnt it . They are highly motivated to stay on the field for intrinsic reasons and extrinsic. They dont want anyone else to perceive them as being weak or letting their team down or not being able to do what they have agreed to do for their team. I preach how important it is that they be honest with me. I show them videos of athletes that have suffered longterm consequences which admittedly scares them into hopefully being more honest with me. A big thing in dc is the athletic trainers have a lot of autonomy. We do not report to any of the athletic personnel. There is no part of my job dependent on the outcome of any athletic event so i can stand my ground. If a coach or overeager parent or anyone else disagrees with me all i have to do is turn to the head official and thats the end of it. Thats not true everywhere. That medical model is what needs to be pushed. They mentioned it in the last panel and thats critical. If im afraid of my job or losing my job and my going to always make the decision that i need to make for my patient . You went to a neurology clinic . What did they tell you. I went there two months ago. They told me that i had postconcussion syndrome. I was telling them all of my symptoms because i took some time to think about it and what i was going through. Is it helping . Yes tremendously. I saw that you put on twitter a couple months ago because of the concussions you are going to stop playing football. I understand that you changed your mind . I have not decided because my neurologist has not cleared me to go back to full Contact Sports yet. What is your hope . Do you hope to keep playing . I just hope i can do Contact Sports of any kind again. He mentions not having a lot of education on concussions. What did you know . What did your high school provide . Wade were taught the right techniques to tackle but as far as symptoms and a feeling of a concussion we were told very much. What would have helped . Being told what the symptoms of a concussion are. What is your approach . What i think is the most important is trying to create a culture where communication is immediate and comfortable and open and an understanding that you may have to in the short term make a small sacrifice as far as being out of practice or a game as opposed to not communicating the situation and having the longterm effects. So whether we are talking about concussion or an ankle not reporting that in a timely manner it ends up being worse in the long run. So just having great communication consistently with regard to do whatever the injuries are a think it goes a long way and really helping everybody get what they want. The athletes want to play. They want to be on the field or in the court or on the ice. They want to participate. Which as alluded to earlier they do not always communicate whatever the pressures they are feeling extremely or whatever they are they want to play. So create a culture that it is understood that communicate your illness or injuries in a timely manner. So that folks like jennifer can help these young men. What you think High School Age players need to know . Like most states we do require parental notification of the signs and symptoms of a concussion. They sign off on a cbc form that athletes have to sign it as well. We hope that they read it before they sign it. It does have the signs and symptoms of what to look for. The coaches have to take the concussion awareness video. We ran into the first couple years and they thought they knew as much as i did about concussions so they did not need to come find me when they thought an athlete had sustained a concussion so we had to revisit that act coaching meetings. But basically just making them very aware of what a concussion is that no two are the same. Your own wont be the same. It may be as subtle as he cannot sleep very well anymore and all of those things need to be reported when youre concerned about what is going on. If there is any change after a suspected had collision or that it does not always take a had collision. That it is not just a direct blow to the head that can cause a concussion. So like i said i show them videos. We usually take pictures to ohio and i have a seven hour captive audience and my coach is very cooperative and letting me show them videos to let them know what they need to be looking for. The buddy system helps a lot. I would frequently have a kid come to me and say somebody is not acting right in the huddle so can you take a look at them. If you do something comparatively and you think that there are symptoms later. In your mind, do you think it has value . I think it has value as a tool. We use baseline testing in washington, d. C. We have a great resource in the Childrens Court clinic they anecdotally do not necessarily feel it is completely necessary for them to have the baseline scores when they are evaluating or treating but it can also be a good tool to have objective data to show the coach. If they are getting antsy i can use that to my advantage. It is one more thing that takes it away from them thinking it is my opinion. Concussions are difficult. You cant see the swelling. You cannot see the bruise there is no lack of function in the joints. It is a little bit harder. I think even athletes when their symptoms linger. We are working on making sure. That should be an imperative part. If they are not meeting their academic rigors they have to do the cognitive work first. How often do you use baseline . We do it every two years. They come in as freshmen and usually again as juniors. We dont do it right away. It is an overview. We talk about modes of contact and practice so for us we have different tempos like a biz tempo which would be a walk through tempo. We have attacked tempo which is moving at a good speed with no contact with the players. We have a tempo which was mentioned earlier which was contact but no to the ground contact. Which you would in a typical season. That was the it would be 3 to 6 ways over the course of the week that we would do most of the contact that would be done. We would do less than five. There is the phrase like less is more. Sometimes we think more is my whether it is lifting weights seven days a week for seven hours a day. Like you have to eat or die or go the other way. Sometimes its what you do and moderation. It is something to prepare you for the rigors of the game and also not to over train or over exert were overexposed. The players and the athletes want to play they want to be out there. How can we prepare them in a way but also consistently in terms of the durability. So for us you ask about how it affects the performance. With limited repetition. They would like to have tackling drills to the ground. It is a practice day. It is learned by watching the videotape. Some of it is going to be walking through. Some of it is going to be not contact work or minimal contact drill work. It is those things to prepare the players to be able to play fast and play well. It is as far as how we prepare and plan and everything happens. You are able to play fast. A lot of it is mental. They would be in a limited fashion where you are not jeopardizing the assets. We would do move two days a week. Tuesday and wednesday. Then we would have a regular practice and we would have 22. We would practice for about 5 to 6. We would do full contact thats about all we would really do was full contact. The whole practice . Not just those five or six. Do you have a preference . How much do you think is too much hitting. I think we did it pretty well. I think five twice a week is not terrible. To you have any perspective on this. We follow the same guidelines. I probably could not put a timeline on doing other things while they are hitting but it is very minimal. When we talk about hitting it it is also the type of drills that occur as well. So they would have one player in the middle and everybody is around with the defensive lineman hitting each other. To those still occur in High School Football . They do. They should not. It took some education. It takes some convincing of the coach that it is not game specific. Why would you practice that. Increased incidence of injury to your own players during those grills helped convince the coaches. I would not say it has been eliminated everywhere. I hear about that more in use than athletics. You hear that more there than in high school. The other thing i would say relative to that it is staying off the ground. So if you have contact on your feet that is the sort shoulder injury. Or the head injury is set. So staying on her feet when we have a big emphasis on the and having a fundamental foundation. When the player with had the eyesore the court or the dirt when the head hits for the shoulder or the elbow that is all the time to think of the injury so we try to postpone it and stay on our feet. I think that is critical. I have not seen that one in a while but i am not at every high school practice. I do see it in the youth league a little bit. Do you play with these, cody . I remember six through eighth grade we would do a little bit but in high school we dont do that kind of stuff. I want to switch and talk about Mental Health. We talked a lot about football which is a very tough sport. Cody you were telling us about fighting depression. Why did you decide to speak out. He came to me right after practice one day. The News Reporter from the Des Moines Register and he asked if i would like to share my story and i thought it would be a good idea because i know that theres a lot of people going through the same thing what did you notice that was wrong with the. What symptoms did you see . Just not been myself. Losing my appetite. Not being sad or happy just nothing. It is really just difficult because it is something that you cannot physically fight. It makes it a lot harder that way. It is a lonely feeling. Who did you turn to for help . A friend of my mom and also my coach. We talked about your concussions earlier. Dear doctors think there is any link between the concussions and the depression . Do you have any idea about that . Once i went to the neurology clinic in minnesota he said it was most likely from a concussion. Just the severity of the concussions probably did something. Football as we have talked about is a violent sport. The players play through pain. How hard is it for you to raise your hand and say i need help, i denied it for a long time. Probably eight months. My did you deny it . I did not want to be seen as weak or less than i did not want people to think i was sad all the time. Thats not really what it is. What would you like people to know when it comes to Mental Health . Know that its okay if you are going through something because most likely you are going to get through it. Its okay to ask for help because Everybody Needs help from time to time. How do we get players to raise their hand. They talk about it. They want to stay on the field and they want to play. How do we think about the culture where it can be okay to raise your hand or if you are a teammate and you see somebody struggling to raise their hand. I think that is another value of an athletic trainer. We are usually a safe haven for the athletes that they can come to talk to with very little risk of backlash. We generally do not have disciplinarian relationships with our athletes. I like to joke and tell my athletes that i get paid a lot for the coaches to you let me succumb to me. That lets the kids know that they can come and talk to me. Isaiah for just giving you a hard time just shrug and roll your eyes and say that it is my fault. Let me take the heat for that. They know that it is one route they can go. There is so much more open dialogue about Mental Health right now as well that it has been beneficial for the students. To be selfaware that they are struggling and the need help and to look for adults that can help them through what they are struggling with. He talked about the culture of the environment. Are there some specifics best practices about how do you get somebody to raise his hand when he is hurt . I think a couple of words that you brought up we really try to create a culture where there is trust and love so i want a young man to be able to walk into my office and be able to ask questions or share information that may not be the popular thing to say in front of the group but to be able to feel like they can come to me with it and know that i will be there for them and will not judge. And to be able to show through action the student athletes that you do care beyond the ability to score touchdowns and block and tackle. As young men and you can have a rapport and a culture where it is more than just a football thing. It opens up doors and avenues for conversation like that if a young man is having issues whether they are physical or emotional issues to be able to share and talk with each other amongst the group and with coaches. Its breaking down some of the traditional tough guy things if you will whether it is the head football coach telling the team how he feels from his heart, crying in from of the team perhaps. Those things i think are real. Showing that there is nothing weak about vulnerability. We all experience the these things. I think that is important because going back to communication we can know what is going on inside of a young mans head and his heart if theres no way to sometimes communicate. With years of experience i can observe body language and tone and things like that but sometimes there are things going on that we cant know unless there is some way that we are communicating. So the habit of creating a culture where the players and student athletes feel safe to be able to communicate and jennifer said that sometimes she is a safe haven for the guys but you hope that the guys feel that way with the Coaching Staff and their teammates as well. You told me something earlier that i thought could be a really good best practice for coaches. I think you said after every game you have the position coach meet with all of the players and check on them physically or mentally to describe what they do and what are they get out of that. So post game in the locker room i will make some announcements and one of those will be that every player make sure before you leave today you see the athletic Training Staff if you have any issue or ailment if theres something thats been bothering you before or maybe something that popped up today. I will let all of the coaches know and i will mention at the time make sure that you see every one of your players before they leave campus today so that we are aware of anything mentally and emotionally that maybe going on with them. Check in with them and it might be a 10 second conversation but we want everybody to facilitate that communication. The last thing really quick for each of you may be one take away when it comes to best practices when it comes to High School Football. Jennifer, anything come to mind . My big takeaway is to leave your ego at the door and admit that theres a lot you dont know and you should never stop learning and never stop Getting Better at what you do. I been a certified athletic trainer for nearly 30 years and if i stop learning when i left school i would be a horrid athletic trainer. You just have to be aware that everything changes and evolves any need to change and evolve with it. I cannot agree more with jennifer. 24 or 25 years of coaching always evolving and trying to find better ways of doing it. So the idea that we brought up earlier practice time and how we allocate the time during a typical week and when during the week we would do certain contact drills and how much load we would put on the athletes as far as what they are doing so i have made changes from year to year and i am sure that i will continue to do that as i continue to learn but i know that we made some changes to years ago in the practice routine as far as which days we wore helmets and which way we were shoulder pads and which days we were full year just for the purpose of the health of the players. So i am going to continue to learn and one of the best things that we can all do is continues to communicate that dialogue and learn ways to keep a great game safe. And cody . I just really want people to educate their players. What they do not know can hurt them and it can have long Lasting Impact on their lives that may not be positive but they can also be very positive. Thank you very much. Please give the panel a round of applause. Just a quick reminder you can learn more about High School Football. This