Coaches: Improve Concussion Safety By Creating Safe Environment For Athlete Self-Reporting
The blame game
Why do such attitudes among coaches and parents persist, who’s to blame, and more importantly, what can be done about it? A lot has to do with the pervasive “warrior mentality” of contact and collision sports, but parents and coaches also point fingers at each other.
Nearly half of all coaches in a 2012 survey by SafeKids Worldwide [4] reported being pressured by parents, or the kids themselves, to play an injured child during a game, with the most notable pressure coming from parents, and being directed towards paid coaches, demands which may be hindering coaches’ ability to keep player safety as a top priority.
For their part, fully half of parents with children age 12 to 17 playing school sports admitted in the same 2012 survey to knowing a coach who returned a player to sports too soon after a concussion, althought it is unclear whether such coaches did so as a result of a win-at-all-costs attitude or due to a lack of education about concussion, since an alarming half (52%) of all coaches in the survey reported holding the mistaken belief that there was an acceptable amount of head contact (ie. getting their “bell rung”, seeing stars) young athletes could sustain without potentially causing a serious brain injury. Most worrisome was the fact that the percentages of those who felt this way was highest among younger coaches under age 35, male coaches, and paid coaches, and was despite the fact that 9 out of 10 coaches knew that most concussions occur without a loss of consciousness.
Concussion seriousness downplayed
That many players (and presumably coaches) continue to downplay the seriousness of concussive events by labeling them ‘bell ringers” or “dings” was highlighted in a 2013 study [5] by the same group of researchers at WakeMed Health and Hospitals, Raleigh, NC, the University of North Carolina at Chapel Hill, and A.T. Still University in Mesa, Arizona involved in the attitude study (“reporting study”), which found that a disturbingly low 13% of the high school athletes surveyed admitted to reporting events they considered bell ringers, most but not all of which were likely concussive injuries.
The study also found that many athletes indicated only moderate agreement with the statement that concussion symptoms were serious, and many believed reporting concussions to be somewhat embarrassing.
Along with their companion study finding that the attitudes of coaches, teammates and parents were the strongest influencers of reporting behavior by student-athletes, [1] these findings led study author Johna Register-Mihalik, Ph.D, LAT, ATC, Senior Research Associate at WakeMed Health and Hospitals in Raleigh, NC, and her colleagues to recommend more concussion education for athletes, parents and coaches about the signs and symptoms of concussion (including not just the most common athletes experience, such as headache and dizziness, but those experienced less often, such as nausea and amnesia), the serious nature of concussive injuries and the need to report bell-ringing events that might be considered so ‘mild’ that they go unreported.
Creating safe concussion reporting environment
In addition, though, because they recognized that “knowledge alone does not equal behavior,” and that “individuals may understand and believe that concussion is a serious injury and even a medical concern” but they may still not report the injury “if they also believe that their peers or coaches will take issue with their reporting their injury or that they may lose substantial playing time,” Register-Mihalik and her colleagues also called for steps to be taken to “create an environment that rewards positive concussion-care seeking behaviors such as reporting an injury or removing one’s self from play when experiencing concussive symptoms.”
They offered as examples of steps that might be taken to create a safe concussion reporting environment having the athletic director at the school bringing in medical providers from the community to talk about concussion, and a coach being understanding and supportive when an athlete reports concussive symptoms and is unable to continue playing, especially in front of other athletes.” In addition, “parents play a key role in driving coaches to be aware and to create this environment at home,” Register-Mihalik said in an interview with MomsTEAM’s Lindsey Straus.
Concussion education of coaches and the creation of a safe reporting environment, said the concussion reporting study, is particularly important given the role the coach often plays in initiating medical care in the event an athlete is injured; the fact that, while coaches do not have the same training as medical professionals and reporting to a coach is admittedly very different from reporting to a medical professional, coaches are often the authority figure to whom individuals turn to report a concussion or other injury; and the reality that less than half of all U.S. high schools have access to a certified athletic trainer.
