SEQUIM, Wash. -- Battle-tested and a little weary from last fall’s high school football season, Travis Anderson, an experienced EMT and paramedic John Riley, understand the nuances of concussions. Athletes who — if they are conscious – say they are ‘fine,’ coaches who may not be sure an athlete needs medical attention, and parents told by ER staff that rest is the prescription for recovery, trying to make sense of the mountain of hospital medical bills. They’ve seen it all, and it’s not easy. First responders like Anderson and Riley from Clallam County Fire District #3 in Sequim, Wash., are a luxury for school districts around the country. Part of a crew made up of paid staff and volunteers, they wait in the corners until given the signal by a coach or referee, or a player goes down and stays there. Like other on-field personnel they can’t see every impact and don’t always know if an athlete is deteriorating on the bench after a big hit. They depend on an educated coaching staff and fellow teammates for their cues. Anderson said,”We’d like to be called sooner rather than later. If there’s any question, especially with a suspected concussion, call us.” Too little care Only about 42 percent of high schools nationally employ athletic trainers, a dismal number in the eyes of many concussion experts who continue to advise against any school district or private organization offering contact sports without proper sideline medical care. Given the budget crises facing many school districts, it is not surprising so few heed this advice. But the challenges in rural areas are even greater. Long distances separate football fields from hospitals and fire stations can serve several high schools. Resources are simply too lean. Many sports-related concussions “Our fire department provides sideline staff for high school football games, and as many junior varsity games as we can. We consider it part of our community service effort and quite frankly, we feel strongly about protecting our student-athletes and their futures,” said District #3’s Fire Chief, Steve Vogel. His first responders have been on the sidelines at Sequim School District's games since 1982. Chief Vogel’s staff has a long history dealing with sports concussions. Former Sequim football player Adrien Gault suffered a catastrophic brain injury during a game in 2006 and was airlifted to a Seattle trauma center where doctors gave him a four-percent chance of survival. He continues to work through his recovery. This past fall, a Sequim student suffered a brain aneurysm during a Friday afternoon PE class and died a few days later. That same Friday there were six significant concussions on the football field a few hundred yards away, said a well-informed source, turning the field into a war zone. Fire District #3 was there for it all. “There were more concussions during that one game than I’ve seen in my entire career, including my time as a running back in high school,” said Anderson. “It was a rarity.” Neither he nor Riley, who played tight end in high school remember suffering concussions during their football careers. They believe they’re seeing so many due to increased awareness trickling down from the NFL. Anderson said, “I think the attention on the concussion issue in the NFL is having an affect on all levels of the game, all the way down to the youngest players.” Emergency Medical Services for Children (EMSC) Guidelines and training for first responders come in the form of online education modules and concussion-related drills practiced several times a year. Soon-to-be-released state protocols developed by emergency room physicians, critical care nurses, EMTs, and others who make up the state committee of the federal Emergency Medical Services for Children program include a sports-concussion guide for first responders. Upon distribution, this document will provide a handy reference for those who attend youth and high school athletic events. “The Emergency Medical Services for Children (EMSC) program works to ensure proper pediatric care is available on ambulances and in hospital emergency departments nationwide,” said Ian Weston, Co-Director of the EMSC program headquartered in suburban Wash. D.C. “Emergency care providers are integral in ensuring our children get the right care when it counts.” When to call 911 Concussion symptoms can be subtle and may not appear right away, leaving room for mistakes to be made if athletes are not properly monitored when a concussion is suspected. The following are symptoms that require a call for emergency evaluation: •headaches that worsen •seizures •neck pain •very drowsy, can't be awakened •repeated vomiting •increasing confusion or irritability •weakness, numbness in arms and legs •unable to recognize people/places, less responsive than usual For more information see Should we call 911?, signs and symptoms Photo: (L) John Riley (firefighter/paramedic); (R) Travis Anderson (firefighter/EMT) Questions/comments? contact Jean Rickerson at jean@SportsConcussions.org

MINNEAPOLIS – A new study suggests that head impacts experienced during contact sports such as football and hockey may worsen some college athletes’ ability to acquire new information. The research is published in the May 16, 2012, online issue of Neurology®, the medical journal of the American Academy of Neurology. The study involved college athletes at three Division I schools and compared 214 athletes in contact sports to 45 athletes in non-contact sports such as track, crew and Nordic skiing at the beginning and at the end of their seasons. The contact sport athletes wore special helmets that recorded the acceleration speed and other data at the time of any head impact. The contact sport athletes experienced an average of 469 head impacts during the season. Athletes were not included in the study if they were diagnosed with a concussion during the season. All of the athletes took tests of thinking and memory skills before and after the season. A total of 45 contact sport athletes and 55 non-contact sport athletes from one of the schools also took an additional set of tests of concentration, working memory and other skills. “The good news is that overall there were few differences in the test results between the athletes in contact sports and the athletes in non-contact sports,” said study author Thomas W. McAllister, MD, of The Geisel School of Medicine at Dartmouth in Lebanon, N.H. “But we did find that a higher percentage of the contact sport athletes had lower scores than would have been predicted after the season on a measure of new learning than the non-contact sport athletes.” A total of 22 percent of the contact sport athletes performed worse than expected on the test of new learning, compared to four percent of the non-contact sport athletes. McAllister noted that the study did not find differences in test results between the two groups of athletes at the beginning of the season, suggesting that the cumulative head impacts that contact athletes had incurred over many previous seasons did not result in reduced thinking and memory skills in the overall group. “These results are somewhat reassuring, given the recent heightened concern about the potential negative effects of these sports,” he said. “Nevertheless, the findings do suggest that repetitive head impacts may have a negative effect on some athletes.” McAllister said it’s possible that some people may be genetically more sensitive to head impacts. The study was supported by the National Institutes of Health and the National Operating Committee on Standards for Athletic Equipment. Source: American Academy of Neurology -- May 16, 2012 Questions/comments? contact Jean Rickerson at Jean@SportsConcussions.org Photo courtesy of JamieLWilliams (c)2006 CreativeCommons.com

USA Football and Steelers' staff had a host of recommendations for increasing concussion safety for area youth football players at Saturday's coaches clinic at the UPMC Sports Complex in Pittsburgh. Know the signs and symptoms. Teach proper tackling technique. Limit full-contact padded practices. "The whole idea is to help our kids play the game of football the right way," Steelers president Art Rooney II said to nearly 100 youth coaches, according to the Pittsburgh-Post Gazette. The Centers for Disease Control and Prevention estimates there are 3.8 million sports and recreation-related concussion annually. Most injuries are sustained while bicycling, followed by organized contact sports such as football and ice hockey and playground mishaps. Last month, data were released on the forces incurred over the course of a full season by 7- and 8-year-old football players in northern Virginia. The magnitude of the hits were measured using accelerometers placed inside several helmets. Many were comparable to forces felt in a pillow fight, but some were on par with those sustained by high school or collegiate players. The higher magnitude forces typically occurred during practices, not games. Ed Passino, Northeast regional manager for USA Football urged coaches to limit full-contact practices. "One thing that we're teaching throughout the country is that you don't have to hit every day in practice," Passino said. "It's not 1950 anymore. Update the way you handle practice. "Maybe you only hit one day a week, you can still conduct form tackling without full-on collisions." The eight Ivy League presidents, two of whom are medical doctors, limited contact practices for their football teams last summer, allowing fewer than the NCAA. USA Football concussion safety information Source: Concussions at head of youth coaches camp -- Pittsburgh-Post Gazette -- May 20, 2012 Questions/comments? contact Jean Rickerson at jean@SportsConcussions.org 7 completed 18 scheduled

Starting in 2012, helmet reconditioners will no longer accept helmets 10 years or older. Leagues that have depended on reconditioning their helmets every year and cannot afford replacement gear will be most affected. Although helmets do not prevent concussions, most experts agree that newer ones are preferable to used, and an older, unreconditioned helmet might increase the risk of injury. Many leagues ask their booster clubs for assistance with fundraising as this issue has now reached a critical phase. Limited grants for replacement helmets by leading manufacturers are now available for eligible youth leagues in several areas around the country. Applications are now being accepted for youth football programs seeking to replace their league's helmets before the start of the 2012 season. The Centers for Disease Control and Prevention, USA Football and partnering organizations have introduced a helmet replacement program for youth in underserved communities. It is estimated the program will provide almost 13,000 new helmets to athletes in low-income communities beginning in July 2012. To qualify a league must meet the following criteria: - Operate a youth football league (no middle or high school programs) - Live in one of the following areas: Cleveland, New Orleans, New York, or the San Francisco Bay area - Serve an economically disadvantaged area The application process requires registration at USA Football, the governing body for youth football under the NFL. The application is accessible only after viewing a concussion awareness video and pledging to utilize USA Football's resources to educate members of your league before the 2012 season. A visit from an official to verify the ages and number of helmets exceeding 10 years of age in your inventory will occur by mid-June, with new helmets arriving prior to the beginning of the 2012 season. Participating helmet manufacturers include Rawlings, Xenith, Riddell and Schutt. Questions/comments? contact Jean Rickerson at jean@SportsConcussions.org

The first of three private screenings was held in Chicago on May 15th for "Head Games," a documentary on the sports concussion crisis. From acclaimed director Steve James (Hoop Dreams, The Interrupters) and award-winning producer Bruce Sheridan, Head Games takes a deeper look at the devastating and long-term effects of concussions in all sports. Inspired by events from the book Head Games written by Christopher Nowinski, the film offers eye-opening insight and cutting-edge science on head trauma from the nation’s leading medical experts. Additional screenings will be held June 6 at the Boston University School of Medicine Albany Street Auditorium and June 7 in Philadelphia at the Translational Research Center (TRC) Rubenstein Auditorium. Watch the trailer Questions/comments? contact Jean Rickerson at Jean@SportsConcussions.org

New Findings Provide Important Data for Refining Diagnosis Postmortem analysis of the brains of ten professional athletes with chronic traumatic encephalopathy (CTE) provides new insights into the specific types of brain abnormalities associated with this diagnosis, reports a study in the July 2011 issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health. The findings may help to refine the cellular criteria for making the postmortem diagnosis of CTE, provide initial clues as to some possible subytpes, and improve identification of cases. The study was led by Drs. Bennet I. Omalu and Julian Bailes of the Brain Injury Research Institute at West Virginia University.Detailed Information on Brain Abnormalities in CTE The researchers performed a detailed evaluation of autopsy brain specimens from 14 professional athletes and three high school football players who died unexpectedly. The goal was to take an in-depth looks at the cellular-level abnormalities associated with chronic traumatic encephalopathy (CTE)—a progressive neurodegenerative disease caused by repeated head trauma, seen especially in high-level competitive athletes. Patients with CTE develop mood disorders, cognitive dysfunction, and other psychiatric symptoms, typically occurring years after a history of repeated concussions. Drs. Omalu and Bailes have played a pivotal role in CTE research, having reported on the first three cases of CTE in American football players. Of the 14 professional athletes in the study, ten had autopsy brain findings consistent with a diagnosis of CTE. The CTE cases were seven football players, two wrestlers, and one boxer. Most died from non-natural causes—mainly suicide or trauma. The authors present a detailed analysis of the neuropathological findings in their cases of CTE. The main feature was "neurofibrillary tangles" (NFTs) and "neuritic threads" (NTs) scattered in different areas of the brain. The brains also show evidence of localized areas of brain trauma occurring amny years previously. Findings Suggest Possible 'Emerging' Subtypes None of the athletes with CTE had the characteristic brain atrophy (shrinkage) of Alzheimer's disease. None of the brains showed the widespread amyloid deposits typical of Alzheimer's disease, but some had scattered to frequent amyloid deposits. Although there are not yet enough cases to develop a true classification system, the authors identify some possible "emerging phenotypes" of CTE, based on the number and location of NFTs and NTs and amyloid deposits. The researchers also examined the brains of three high school football players who died of trauma sustained during competition. None of these young athletes met criteria for a diagnosis of CTE. However, one brain showed early, "incipient" abnormalities similar to those of CTE brains, likely related to repeated brain injury. Since the first reported case in 2002, there has been growing concern about CTE and other consequences of repeated head trauma and concussions in football players and other athletes. The findings have led to renewed discussion of the consequences of head trauma—not only in athletes, but also in other high-risk groups such as combat veterans. The Brain Injury Research Institute was created to study the short and long-term impact of brain injury and concussions and the development of CTE. Drs. Omalu and Bailes and colleagues hope their findings will contribute to further research into the neurological and psychosocial impact of CTE. In addition to proposing some possible subtypes of CTE, they suggest a set of pathological tests to be performed in diagnostic investigation of possible CTE. They believe that "CTE diagnosis and surveillance should become intrinsic components of routine patient care work-ups and routine hospital/medical examiner autopsies in high risk cohorts like athletes." Source: Study Takes a Closer Look at Brain Abnormalities in Athletes with CTE -- Lippincott Williams & Wilkins -- Newswise July 12, 2011 Questions/comments? Contact Jean Rickerson at Jean@SportsConcussions.org

Coy Wire was a team captain for the Buffalo Bills (2002-2007) and the Atlanta Falcons (2008-2011) during his nine years in the NFL. An All-American Honors athlete at Stanford University, Coy was the first player to lead the Cardinal in both rushing and tackles. He was a recipient of the NFL’s Ed Block Courage Award. Q: What would you tell athletes about concussions? The NFL is in a state of evolution and recent changes will only make it safer for younger athletes. The league and the NFLPA (National Football League Players’ Association) have made huge strides to address the concussion issue, while maintaining the excitement of the game for both fans and players. It’s important that all athletes remember that you only get one brain and as we learn more about the long-term and adverse effects of contact sports and repetitive head injury, we know that smaller hits over the course of a career- even a high school career- can accumulate. Learn to recognize the symptoms of head trauma. You can have headaches or you might be slightly dizzy …these are all bearable and many athletes mask these symptoms by taking a Tylenol and then they go out and play again. But a concussion is not an ankle or shoulder injury…later in life you can have surgery on that ankle or have knee replacement surgery but you only get one brain. You can’t get a brain replacement. If you mask head trauma you can be risking increased problems in the future for Alzheimer’s or dementia. Head trauma has to be looked at very differently. Yes, in a way it’s a body part like a shoulder, but your brain must be treated very differently. You can ice and elevate an ankle but can’t do that with your brain. Real damage may show up later in life …and it’s not just football, it can happen in any sport. We used to look at toughness and playing through injuries as a badge of honor. That you were tough both mentally and physically and that continuing to play while hurt brought you the respect of your peers. But we need to change the culture now, and that starts with you. You need to believe that it’s OK to miss a game or a week or longer. If you do have to sit out, it means you were playing hard and you took one for the team. You shouldn’t feel ashamed. And if you care about your friends and your teammates, keep them from harm. If you see a friend of yours doing something to hurt themselves, like playing with a concussion, step up and help them. You’re doing them a huge injustice by allowing them to continue to plhttps:// are your brother’s keeper. Become a hero in their life and help them realize what they probably know deep down inside anyway. Someday they’ll look back and know what you did for them, and they’ll respect you more, later in their lives. Be a leader and help change the game. Help create a new norm. Coy Wire is the author of Change Your Mind; 10 Unconventional Secrets to Retrain Your Brain; March 2012. He is an inspirational speaker and mind coach. For more information contact him at https://www.coywire.com/

Alzheimer’s disease and Chronic Traumatic Encephalopathy (CTE) are both “neurodegenerative diseases.” That is, they are brain diseases that result in the progressive destruction of brain cells, eventually leading to cognitive, behavioral, and other impairments. Both diseases also lead to dementia. The distinction between Alzheimer’s and dementia is very often misunderstood, even by many doctors. “Dementia” is a clinical syndrome defined by memory and other cognitive impairments that are severe enough to cause difficulties in social and/or occupational functioning (i.e., reduced independence in functioning). Dementia is not an illness or a disease. Dementia is not a “mild” form of Alzheimer’s. Rather, it is analogous to “fever,” in that it tells you that you are sick, but doesn’t say what is causing the problem. Similarly, dementia means that there is something wrong with the brain’s functioning, but not what is causing it. Several illnesses and diseases can lead to dementia, including Alzheimer’s disease which accounts for approximately 75% of all cases of dementia. However, several other neurodegenerative diseases result in dementia, including CTE. Alzheimer’s and CTE are distinct diseases. Both Alzheimer’s and CTE can only be accurately diagnosed postmortem through a neuropathological examination of the brain. There have been several new scientific breakthroughs over the past few years that now allow doctors and scientists to be much more accurate in diagnosing Alzheimer’s during life. However, at this time, there is no method of diagnosing CTE during life, although our group at the Boston University Center for the Study of Traumatic Encephalopathy (CSTE) recently received a grant from the National Institutes of Health to begin developing these types of tests. One of the major differences between Alzheimer’s and CTE involves what causes each of the diseases. There is no known specific risk factor that leads to Alzheimer’s. For CTE, however, it is believed that repetitive brain trauma (including concussions and subconcussive blows to the head) is a necessary, but not sufficient risk factor. That is, everyone that has been found to have CTE in postmortem examination has had a history of repetitive brain trauma, including athletes (e.g., football and hockey players, boxers and wrestlers), as well as others, such as combat military personnel, developmentally disabled individuals who repeatedly bang their heads, and victims of domestic abuse. Boxers and football players (especially lineman) appear to be the most likely to get the disease because of the repetitive brain trauma exposure. But, it is important to note that not everyone with a history of repetitive brain trauma will develop CTE. Our center is currently conducting research into the other potential additive risk factors, such as genetics, age of initial brain trauma exposure, frequency and overall duration of exposure, etc. This research will hopefully lead us to understand why one person gets the disease and another person does not. This line of investigation, along with our new study to develop methods of diagnosing CTE during life, will eventually lead to effective treatments and prevention strategies. Robert A. Stern, Ph.D. is a Professor of Neurology and Neurosurgery; Co-Director, Center for the Study of Traumatic Encephalopathy; Director, Clinical Core, BU Alzheimer's Disease Center, Boston University School of Medicine.

The apparent self-inflicted death of legendary NFL linebacker Junior Seau has sent a shock wave throughout the world of sports. Seau played professional football for nineteen years for the Chargers, Dolphins and Patriots and was a 12 time Pro Bowl selection. His flamboyant playing style and jolting hits electrified fans for years. He was 43 years old. This is a time for grief and remembrance. Seau was an integral part of the San Diego community and dedicated time and effort to his charitable foundation. His family needs prayers and support. Normally, speculation as to causation would be premature, but these are not normal times. The spectre of head injury and the disastrous lifetime ramifications call for emphatic action. There is a largely undiagnosed health epidemic which has surrounded contact sports at the youth sports, high school, collegiate and professional level and it is a ticking time bomb. For many years a veil of denial has obscured the reality of what the long term impact of multiple concussions portend. I first became concerned in the late 80's and 90's when I represented half the starting quarterbacks in the National Football League. As I went with clients like Troy Aikman and Steve Young to post-concussion visits with neurologists there were too many unanswered questions. How many head injuries is too many? What are the long term ramifications? How long should a player sit out after suffering the hit? Physicians had few concrete answers, the brain was the last frontier of medical research. I finally decided that I could not in good conscience represent players in a sport that we intuitively knew could cause devestating consequences to the mental faculties of athletes, without becoming an active crusader to raise awareness of the danger. I felt like an "enabler" facilitating a "meat grinder" career. In the 90's we held three concussion conferences in Newport Beach with the leading neurologists, helmet manufacturers, and playing surface representatives talking to Steve, Troy, Warren Moon, Drew Bledsoe and many other clients. We issued a white paper calling for a standardized regimen of diagnosis and "return to play protocols." We urged better helmetry and protective devices. We asked for a neurologist to be put on the sideline and that the head and neck be banned from blocking and tackling. Not much changed. The players themselves were in a state of denial concerning physical health. They had been taught from Pop Warner on to ignore pain, hide injury so as to not lose their starting position or jeopardize their status on the team. They didn't want to be known as "training room" players and be stigmatized and isolated from their peers. They were young men and athletes, two categories that viewed long term health as an abstraction. The most critical priority for them was the next play. And retired athletes were stoic and didn't talk about impaired memory or depression to younger players. In some cases, because concussion is not visible like a leg injury, they may not have known. In conjunction with the Los Angeles based Concussion Institute we helped facilitate another series of Concussion Seminars seven years ago. This time there was concrete data presented by researchers like Dr. Julian Bailes, Dr. Robert Cantu, Dr. Kevin Guskiewicz and Dr. Robert Hovda that seemed to indicate that three was the "magic number." Three or more concussions apparently raised exponentially the post-career risk of dementia, Parkinson's and depression. Presentations were made about the existence of a genotype-an allele of which produced heightened risk of concussion and severe post-concussion consequences. A pattern developed in which the repetitive head injuries produced chronic traumatic encephalopathy, permanent brain damage. Player's like the Bears' Dave Duerson developed depression. Often loss of job and family would occur. And in some cases, suicide. To their credit, Commissioner Roger Goodell and the NFL responded by convening a physician's conference. They issued a whistleblower edict which urged players to report other impaired players. And they adopted baseline testing, developed by Dr. Mark Lovell. A cognivitive test is given prior to a season and in the case of concussion is followed by a second test. This is an objective way to measure the degree of damage and insure that players are asymptomatic at rest, on an excercise bike, and at practice before they are cleared to play. This is something that every parent should insist on for their "collision sport" children. Pro football may be most visible, but the risk is present in many other sports and at the collegiate, high school and youth levels. The adolescent brain may take three times as long to recover and it is still in formation. The physics of collision have changed -- bigger,stronger, faster athletes colliding with a stationary object. And so the problem will accelerate and not diminish. The simple act of offensive and defensive lineman colliding thousands of times produces low level concussive events. What will the cumulative effect of the injury mean for athletes in their forties and fifties? I knew Junior Seau since the day he and his massive Samoan friends partied back stage as he was drafted in New York City. He was only 43. I represented him for a time. I love sports, but love the individuals who play them more. As Peter, Paul and Mary sang, "How many deaths will it take 'till we know that too many people have died?" We need to find the answers, they can't just be "blowing in the wind." Leigh Steinberg was a sports agent for almost forty years. He represented many of the nation's most recognizable athletes including Troy Aikman, Steve Young, Drew Bledsoe, and Warren Moon. Leigh negotiated over $2 billion in contracts during his career. He was also the inspiration for the 1996 movie Jerry Maguire starring Tom Cruise. He is now CEO of Steinberg Sports and Entertainment located in Los Angeles, California. Leigh is a member of the SportsConcussions.org Advisory Board. Photo, above: (c) 2009 Dave Sizer@creativecommons.com Questions/comments? contact Jean Rickerson at Jean@SportsConcussions.org