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Athletes need more on-site access to medical care, experts say

West Virginia schools need to improve access to athletic trainers and medical providers to help students who suffer sports-related injuries, experts told state lawmakers Monday.

Members of a legislative subcommittee studying the topic of student wellness began looking into student-athlete safety during interim committee meetings at the state Capitol Monday.

Lawmakers have been concerned for some time that the state lacks formal rules for dealing with athlete injuries, particularly for those who suffer concussions during games or practice.

During the meeting, experts told lawmakers every school across the state needed to come up with emergency medical plans that lay out procedures designed to prevent injury or get medical access to students as soon as possible.

"This issue is beyond football, it's beyond high school - it's a global problem we have to address here," said Chris Marr, lobbyist for the West Virginia Athletic Trainers Association.

Right now, the state requires only that a certified athletic trainer to be present at high school football games. No other sports are required to have trainers on-site.

While he said it would be ideal to have an on-site trainer at every sporting event or practice, Marr said that's not possible.

"We have 300 certified trainers in West Virginia; we can't cover everyone," he said.

However, Marr said schools could come up with plans for getting medical help to injured students as quickly as possible.

Dr. Kelly Roush, director of sports medicine services at Holzer Clinic, shared a series of stories with lawmakers about student athletes who suffered from a lack of adequate medical care following injuries.

One story was about the death of a southern Ohio high school student several years ago. He suffered a series of traumatic brain injuries while playing football.

Roush said she was working as an athletic trainer for a high school when she saw an opposing player collapse outside his locker room following the game.

"This kid was knelt down with head in his hands," Roush said. "When he looked up, it was as if his pupils had exploded in front of me."

Roush said this was a telltale sign that the teenager had suffered a brain aneurysm. As she looked at him, the boy lost consciousness and began having a seizure.

He was flown to a hospital, but doctors could not revive him. He died the next day.

It was later determined the boy had suffered a concussion during a football game two weeks earlier, but no one acted on it at the time.

"There were so many signs that got unnoticed," she said.

The boy had been complaining about headaches during the two-week period. After playing a game after the first week, he asked his girlfriend to drive him home because he was dizzy.

His parents took him to a pediatrician, but the doctor diagnosed him with a sinus infection.

Because no one told the boy to stop playing, Roush said the damage kept building until he died.

"Your brain is like a balloon: You blow it up or injure it; it expands; you blow it up again; it continues to expand and swell," she said.

Health and sports officials are beginning to become more proactive about dealing with the long-term effects of sports-related concussions.  

The state Secondary School Activities Commission has taken some steps to address the problem.

The SSAC has a return-to-play protocol for all sports with an underlying philosophy, "When in doubt, sit them out."

Under the protocol, athletes showing possible signs of concussion are to be removed from play immediately and not allowed to return or practice until cleared by a certified medical professional. That professional must have training in the evaluation and management of head injuries.

The SSAC also requires all student athletes to watch a DVD about the risk of concussive-type injuries at the beginning of each sport season.

This year, the SSAC mandated that all middle and high school head coaches complete a 20-minute online course created by the National Federation of State High School Associations. It is aimed at teaching coaches, officials, parents and players about the importance of recognizing and responding to concussions.

Right now, only head coaches have to complete the course prior to the start of any sports season, but SSAC assistant director Ray Londeree said the requirement likely will be extended to assistant coaches.

"There's a really good chance that all coaches may have to take it in the future," he said.

The SSAC's procedures for dealing with concussions came into play during the opening night of the high school football season this year, when George Washington High School standout running back Ryan Switzer suffered a concussion on his first play of the season.

Switzer was initially cleared to play following the injury but was pulled from the game a short time later. His family physician later ordered him to sit out a week.

Londeree emphasized that the attention to concussions must go beyond football.

"Football has the most concussions, we all know that," he said. "Girls soccer has the second highest number of concussions.

"When you take the number of participants, there's about a four times greater chance of a girl playing soccer getting a concussion than a football player," he said.

Dr. Greg Elkins, medical director of the Lincoln Primary Care Center, said he's worked as a volunteer physician for many high school sporting events and tried to educate parents, coaches and officials about athlete safety.

But he pointed out the state currently has a gaping hole in state law to protect volunteer physicians from getting sued should something go wrong while they're administering care.

"We just brought on a new physician this week who is afraid to go to sidelines because he's afraid to get sued if something happens," Elkins said.

Sen. Ron Stollings, D-Boone, said he's also been a volunteer physician at games and didn't realize until last year that the hole exists.

Current law says a doctor can be held liable for civil damages in an amount up to their malpractice liability insurance coverage. If a doctor has $3 million in coverage, that's the amount that can be awarded in a case.

But that protection only comes into play if the doctor enters into a formal agreement with a school administrator to serve as a volunteer physician during a game.

Stollings said if he was just sitting in the stands watching a game, someone got hurt and he tried to help that person, he would have no protection at all.

"It was certainly my understanding when I was going out on the field that I had some type of civil liability protection," he said. "That was basically an eye opener for all the doctors that are team docs."

Elkins said the state should adopt some type of reform to ensure team doctors are protected from malpractice claims.

"I think it's vitally important for our young student athletes to keep that vital health care available on the sidelines," he said. "You do not want to make it difficult to have someone like me or Dr. Stollings or Dr. Roush on the sidelines."

Nearly 40 states have some type of liability coverage for team doctors.

Sen. Erik Wells, D-Kanawha, wants the committee's staff to compile a report on legislation from other states to show lawmakers at next month's committee meetings.

"I think we need to be taking a look at liability coverage and see what other states are doing," Wells said. "We need these folks to come out to the games."



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