Transcripts For CSPAN3 Discussion On Youth Sports Injuries 20160111

Good morning, everybody, and welcome to the National Press clubs Morning Newsmaker Program here in washington, d. C. Todays topic is preventing youth sports concussion and what washington, d. C. , is doing about it. One of the first major metro areas in the region to provide a grant for research, education and monitoring of concussions in youth sports. And were also here to talk about other youth sports injury. This newsmaker panel will offer an examination of data, trends and concussion research, state policies and whether or not the u. S. Department of education should adopt federal compliance mandates. Every state in the union has a concussionrelated law on the books and a sports and youth Injury Program regulation on the books. Enforcement is the issue, and compliance is the issue, and thats what the doctors here this morning and the sports data person is going to be talking to us about. My name is mike smith, and i serve on the National Press Club Newsmaker committee, and the committee is chaired by jamie horwitz, and our staff facilitator is joanne booz who helped us get it started today. Im a columnist for campaigns and elections magazine and a blog writer for huffington post. I also own my Public Affairs shop called greensmith Public Affairs in reston and ive been a member of the National Press club for about 25 years. I tweet as both submittypa and greensmithpr, so youll see a lot of tweets, and our hashtag is dcconcussions, plural. This newsmakers is being broadcast live on cspan and will be Available Online as well at press. Org. And youll find Additional Information under our National Press club site. The website, www. Press. Org. And in the record newsletter following the newsmaker. Various press releases have been put out on the wire concerning Health Research under way here in washington, d. C. About one year ago, washingtons department of health provided a grant to Childrens National medical medstar and the agency for student Health Research also operating with injure free as their Technology Platform to collect data and information from parents, students, teachers and coaches and to provide education about concussion as well as diagnostic and initial screening questions to help student athletes. This newsmaker will refer to a monitoring education and Prevention Program being funded by the d. C. Department of health and will be implemented on the playgrounds of the d. C. Parks and rec department. The will smith movie concussion documenting the life and times of pathologist dr. Bennett amalo has returned attention to the issue of football and concussions. In fact, this morning on cbc sports, theres an item we just saw on the Cable Network about a youth sports cte injury, a young athlete names keck and the student had suffered from cte it was found. So its not just nfl players. The movie noted that the first autopsy which helped identify cte in a pittsburgh Football Player indicated a player might be hit tens of thousands of times in the head by the time they go from peewee to youth to high school up until college and then onward to pro football. The actuarial shows they might suffer from brain trauma or injury. But well not limit this discussion to football or even concussion in youth sports. Were talking about injury across the board. And theres a lot going on with youth soccer and not allowing headers in the early parts of Young Athletes careers. Societys really becoming aware of this issue. And so is congress. And so are the states. And ill just mention a few things that have happened in the last few weeks on the hill and in the statehouses that will allow us to provide for a policy discussion as well as a Technology Platform discussion. Its interesting, as a member of the press club, to see that we have education beat reporters. We have technology, sports, and weve had the health and medical. So this issue traverses a lot of different beats. We want to draw a bit on the recent news on the hill which fred upton has said reaches epidemic proportions as a Public Health issue. Three days before christmas, fred upton called for an investigation of concussions. He announced the broad review in his statement for the health sorry, the house energy and commerce committee. Chairman upton announced theyll discuss a broad injuries in the new year through his oversights on investigations, health and commerce. And this will include medical experts, professionals, nih, military, collegiate sports and the science and Research Community and other stake holders. Upton said we often hear about concussions in the context of Service Members and athletes, but this program goes well beyond the battlefield and gridiron. Its a matter of Public Health as these injuries are prevalent in all ages and across all population. Unfortunately, theres a lot we dont know about head trauma. How it affects different subsets of the population, short and longterm effects and other details critical of affecting diagnostics and treatments. And he said thanks to Public Awareness increasing in recent years, there are promising efforts under way and Congress Wants to better understand that. We have an opportunity to improve our understanding and better care for our kids and families. Another congressional caucus that has begun to take action on this matter is the congressional youth sports caucus. There actually is a congressional youth sports caucus. And two of the chairs are mark vici of texas and ron kind of wisconsin. They work to promote health, safety, fun and physical activity among players, sports leaders and parents. And what weve learned just in talking together is that this is really a partnership between educators, schools, parents, coaches and student athletes. So what is this caucus doing around the issue of concussion . Were finding out in the new year that the caucus plans to meet and continue discussions on youth sports injury as well. And finally, id like to go to the statehouse. And in this case richmond. On a state level, just on the 15th of december last year, the Virginia Commission on youth conducted a study providing a dozen recommendations to the governor, terry mcauliffe, and Virginia Department of education secretary, ann houlton, some of them centered on concussion. The first of which is requesting the department of health and the department of education Work Together to assess the feasibility of conducting regional information training on updated concussion guidelines and concussion awareness. Bdh previously adopted guidelines for policies on discussions of student athletes. So the departments are encouraged, and then the state of virginia, the u. S. Center for Disease Control guidelines, the cdc guidelines which jerry will talk about in a minute and other nationally recognized resources for presenting information to our communities. The information presented should focus on identification of concussion, the use of smartphone applications, and shortterm and longterm Health Effects of concussions and safety precautions. Its interesting that the commission on youth in virginia is asking for smartphone applications. Things that can be used right on site and injurefree is going to talk a little bit about that and the use of big data, cloudbased technology, and the ability to bring it right down to your smartphone on the playing field. So now let me introduce our guest speakers and panelists here at the newsmaker. And what well do is have each of them speak for a few minutes and then well have a roundtable discussion. Dr. Gerard joya is the division chief of neuropsychology and the director of the safe concussion outcome recovery and Education Program at Childrens National Health System, or s. C. O. R. E. Is a professor at g. W. S Medical School and directs the neurobehavioral Core Research labs for Childrens National clinical and Translational Science Institute and the intellectual and Developmental Disabilities research center. Dr. Joya treats persons and families are brain injuries with dual areas of interest involving the executive function and pediatric concussion mild traumatic brain injury. Hes been the Principal Investigator of several cdc funded Research Studies of mild tbi with the focus on development of methods, tools for the evaluation and executive function and postconcussion neuropsychological functioning. Hes developed several smartphone apps, and hell be talking a lot about the d. C. Grant and what were doing to develop this current application. And they have neurocognitive tests for concussion and postconcussion symptom scales for children and parents. He works very closely with cdc on their headsup concussion Educational Programs as contributing author to the toolkit. Dr. Joyas been an active participant in the 2004, 2008 and 2012 International Concussion and sport Group Consensus meeting and the American Academy of neurology sports concussion guideline author panel. Hes a Team Neuropsychologist for the capitals and the baltimore ravens. Although he just told me hes a giants fan. So theres your first scoop. He consults with the local and National Governing organizations of ice hockey, lacrosse, football, soccer and rugby and is on the medical Advisory Committee for usa football and the National Advisory board of the positive coach ago lines. Dr. Michael yokelsen is Vice President of medical affairs at the Medstar National Rehabilitation hospital, medstar here in washington. Hes a boardcertified psychologist and neurologist. Currently he served as medical director of the Brain Injuries Program and associate medical director of the Neurology Program at medstar. He also is the Program Director of the brain injury medicine fellowship training program. Hes a graduate of g. W. Universitys medicine and Health Sciences school and completed his residency training. Previously he served as a staff fission physician, sleep dysfunction and spacity management. Hes an active member of the Brain Injury Association in maryland. Hes an associate professor of clinical neurology and clinical rehabilitation medicine at georgetown and holds an adjunct staff position with the Rand Corporation studying traumatic brain injury in Service Members returning from deployment. He also serves on the fdas scientific Advisory Board for orphan products grant program. Hes received numerous awards including the outstanding educator award in physical medicine and rehab at georgetown. Hes recognized as one of the top docs in washington at medstar. Charlie wand flew from san diego and made it through ohare yesterday. Hes executive director of the agency for student Health Research and founder of the injurefree platform for monitoring, educating and engaging all stakeholders in concussion and other youth sports injury prevention. Injurefree is the cloudbased Data Analytics system powering the works of the doctors. He graduated from marietta where he played four years of football and charlie also played two years of ncaa lacrosse. He studied at San Diego State earning his masters in educational facility design and is a registered educational facility planner. Charlie is a former Elementary School classroom teacher. He was the Athletic Director at the San Diego Jewish academy where he also coached football, baseball, softball and basketball at the school. Charlie was the Athletic Director at the san diego ymca, and he coached football and sorry, baseball and softball at st. Albans there. He founded the agency for student Health Research which then developed this injurefree app and data platforms. So yes, when it comes to traumatic brain injury, theres an app for that. And were going to find out how its being informed. So its been one year since washington, d. C. , provided its grant for the d. C. Department of health. Around march the study work and i guess acquisition of data and information got under way. And were at about the ninemonth mark now of starting to bring in surveys, information from parents, patients, students and dr. Joyas here to tell us a little bit about how thats going and then give us a primer a little more on the issue of youth sports injury. Dr. Joya. Thank you mike. And thank you all for coming to hear about this important issue here. Were talking today about not only concussion and its effect on kids, says but ultimately, what we can do as a society to both prevent, at the very least minimize the effect on kids and families. And were going to talk about the District Of Columbias legislation that was passed several years ago that is really attempting to put prevention and Early Intervention into place. I think its important to recognize that any good policy has to be based on Good Research evidence. On data that allows us to make the best kinds of decisions that we can. And what we know in the field of mild traumatic brain injury, or concussion, is that the research right now for our youth populations is really minimal. In fact, the institute of medicines report in 2013 identified that we were lacking in terms of our ultimate knowledge of this injury in kids. Most of our research has been at the collegiate and professional levels or in a more narrow group of High School Male Football Players. So our ability to make good policy decisions for younger kids and for girls involved in sports is not based on good Scientific Evidence at this point. But nevertheless, we, back in 2009, recognized that we needed to do something. And the state of washington, there was a youngster named zachary lystat who unfortunately sustained two blows to the head in an eighth grade football game. Unbeknownst to his coaches or to his parents. And unfortunately suffered a permanent brain injury. As a result, the state of washington and one of my good friends and colleagues, dr. Stan herring, and the Brain Injury Association, wanted to put out a good educational platform and program for coaches and for parents. And they did that on a voluntary basis. What they found was that when they went out to educate the public, there was, at best, a modest interest in the issue. They then brought it to the statehouse, and they recognized that they were going to have to legislate this process. And the zachary lystat law was passed in 2009. Now, quite amazingly, over the next five years, every state and the district have put a somewhat similar law into place. But i will say that the District Of Columbia has really distinguished itself in its policy, in its legislation in that it, number one, included not Just High School sports, which about twothirds of our laws at this point still only focus on, but also included youth sports, that is kids age 5, 6, 7, 8, it included private schools, not just public schools. It also included what we need to be doing to help kids after the injury occurs, and in particular, how we return somebody to school that is where a youngster goes to work every day. And so its quite the comprehensive program. But i will also say that even more uniquely, they put their money where their mouth was. And they have funded Childrens National Health System and medstar and provided us the opportunity to bring charlie and injurefree in to educate and train coaches and parents to be sure that we are getting to School Nurses to really lay the foundation for making our kids safer. But, again, this is our best guess at this point in terms of what we can do. Youre going to hear a little bit about some of the data that weve been collecting and the work that charlie has been doggedly doing to put a structure in place that will tie together our schools, our families, our medical systems, and our youth sports systems. And id like to think of that as the four corners of a childs life, being able to make sure that when an injury occurs, it affects all four corners. And that information needs to be well disseminated, well communicated and coordinated so that that youngster is getting the best treatment that they can. But again, the law was built to try to identify this problem. Typically by a nonmedical person. That is the coach who may see something happen. And so our efforts in this first year of this project has really been focused on how do we give coaches and parents information to recognize the injury, to know that, number one, if a blow to the head or to the body jerks that individual in such a way but with number two brings along a change in that youngsters function as identified by going through a list of signs and symptoms, then that youngster has to be pulled out of harms way. And they need to be evaluated by a medical professional. And they cannot return to that field of risk, if you will, until theyve been cleared by a medical professional to say that that brain has recovered and is able to handle the return. Those are the three Core Principles of this law. Educating, removing, and making sure that we only return when ready. So im going to stop here and be happy to take some questions. Well hear from dr. Yokelsen on some of the activities that weve been doing in our grant. But again, i want to give just a strong, strong positive message to the d. C. Government for really making this happen and also for the department of health in facilitating it. Thank you. Michael . Thank you very much. Thank you very much for having us and allowing us to come and discuss this very important topic. I wanted to start a little bit by talking about my clinical practice or our clinical practice in medstar and certainly at childrens because i think it really highlights the impact. We are seeing new concussion patients every single day. So throughout the medstar Sports Medicine network, throughout washington, d. C. , and baltimore, we had Sports Medicine and brain injury physicians throughout the region. Similarly through the s. C. O. R. E. Program. Childrens has their program in d. C. Northern virginia and maryland and every single day were seeing new concussion patients. And i think that that really highlights the importance of this. And these are student athletes. These are adult weekend warriors. These are college athletes. These are professional athletes that we are seeing. In my personal practice as a brain injury specialist, i also see the longterm effects. So i am seeing patients who have the signs and symptoms of chronic traumatic encephalopathy or the prolonged postconcussion syndrome, and these are things that the only way we can prevent is to understand, to identify and to get the players out of harms way. And so its through this d. C. Department of health grant that we were able to begin this work. And its extremely early stages of this work. Theres much more to go on. But i just wanted to talk a little bit about a few numbers. So through this program that weve been working on over the past year and certainly hope to continue in the future, we had a total of 29 events. These events included awareness events, direct training, clinician refresher training, and train the trainer sessions. And we touched over 6,000 people during those 29 trainings. One of the things that we also did is we did some pre and posttraining evaluations. We wanted to understand what did people know before they even came to our awareness events or our training sessions. And what we found is that there is truly a lack of understanding of the laws. In fact, theres a lack of understanding that even exists as it relates to concussion training. Overall, it was about 40 of people realized that there were laws. And again, the people that we were assessing are parents, coaches, athletic trainers, nurses and guidance counselors. Certainly some had a better understanding with the athletic trainers scoring at 100 awareness of the laws, thankfully. But parents, it was only 31 of parents admitted to even recognizing that there was a law related to concussions for student athletes. And this is really an indication that this program is a critical program. And what we have found in our efforts doing this is that it is a challenge for us to really get out in front of everybody and do the extensive awareness and training that Everybody Needs because we are utilizing our own resources that are there also to care for these patients, to go out and do this training. So we are a collectively a limited resource, and thats where the use of applications on smart phones, computers and whatever really is a critical piece of this entire program. So certainly you will hear more from charlie about that shortly and what this can bring to the program. But i think its also important, particularly as the concussion movie is now out there and so parents, students, everybody is hearing about this, to recognize that thisis actually a real entity. In terms of the research, much more Research Needs to be done. We are truly in the infancy of understanding how can we prevent concussion, how can we prevent cte, what does it take to develop that . We know that it occurs by recurrent concussions. We also know that you actually dont need a direct blow to the head to get a concussion, but what we dont know is how many concussions you have to have, how severe, how frequent are the concussions in order to develop this, and are there other factors . Are there genetic factors . We suspect that they are. We dont know what they are. So theres certainly a lot of work that needs to be done on the biologic side, on the genetic side. Theres a lot of work that needs to be done in terms of really understanding this screening. Were using impact testing very often in the schools, in the colleges and even in the professional teams to do baseline and postconcussion evaluations. Is that the right tool . How do you use that tool appropriately and effectively. So much more research is needed. I think with the program that d. C. Department of health has funded we are on the right track, but it cant stop now, it has to continue. These numbers show that. The numbers of concussions that were seeing show that. So i appreciate the opportunity for all of you to come, we will be happy to take more questions and i will turn it over to charli charlie. Good morning. Thank you, michael. Thank you, mike and thank you everyone for being here. It really is a great honor to be here and working with medstar and childrens, especially through the initiatives set forth by the department of health. This is a tremendous opportunity for us to show an example for the country of what can be done on a regional level. One of the things we heard from dr. Gioia was the need for more research and certainly the understanding about the issues at hand. As a former coach, as an Athletic Director, i understood the Administrative Burden thats in play here for schools. Paperwork, six, seven, eight different pages of pieces of paper every time there is a return to play protocol put in place for concussions. Certainly for me it was how can we use modern technology in realtime notifications being hipaa and serpa compliant to amplify the efforts of doctors and medical researchers like the two gentlemen here with us today so that we can effect a larger and broader area, but doing that in a coordinated effort. That was really the birth of injure free and how to put something together that was able to meet those goals. Throughout washington, d. C. As we deploy the idea is were going to be able to provide the same level of care for any child who may suffer from potential injury or any other injury other than head injuries. So that would include anyone at the parks and recs facilities in the public sectors, anyone at private institutions, private youth club organizations, schools, pe classrooms, cafeterias, locker rooms, wherever these head injuries may be occurring, also on the football field, on lacrosse fields, in the soccer pitch, whatever it may be. Then as that information comes in, were able to study the effects of that concussion Education Training thats being deployed. In the injury free platform the cdc heads up training and return to play protocols are being put in place so we can electronically dis boout all of the necessary requirements, the signs and symptoms, the recognition for parents, but then also for students, coaches, to complete that training process. Were also doing then making it available for administrators at those levels to be able to check the box, make sure that their populations are going through the required trainings in accordance with the d. C. Concussion act. So this regional effort is something that we want to be able to amplify on a much larger scale, but the idea here is that National Statistics and National Numbers and the rates of concussions that are happening are fantastic. We want to know how we can effect local policy. Here in washington we have been able to look at the effect that this concussion education has on reducing the number of concussions occurring and then continue to work with those laws and the policies in place. Let the data speak towards what actions need to be taken and how we are able to reduce those numbers. So, again, its a great honor and we are excited at the agency for Student Health that we were selected to be put in place here. Were looking forward to continuing to work with childrens and medstar moving forward and excited for what the future can hold. Thank you very much. Thank you. So well take a few questions. Id like to start off with one for the doctors, which is, do you think we will look back in five years and say we just didnt know what we didnt know . It just seems theres almost a meet or i can rise in our ability to collect information, analyze, compare. You talked about more biological and genetic studies, you youve talked more about on the field experiences and what youre seeing. It seems that the media cycle has caught up with concussion in the last few months, but the media cycles pass. Do you think maybe in five years we will have a better handle at exactly whats going on . Gerry . The first thing we have to recognize is the brain is the most complex organ in the body and neuroscience has advanced dramatically over the last decade. I think in five years we will clearly look back and say, we now know so much more than we did five years ago, in the same way that we are looking back now five years ago and saying, our understanding of this injury, even our awareness of this injury has changed dramatically. I do think, though, the challenge is going to be making sure we dont get ahead of ourselves with that, whereas, in all of my active work with the cdc our efforts have been to promote awareness. We also have to make sure that we dont find of overstep where the evidence is, where the Research Really is taking us. Because were making a lot of assumptions right now about this injury, some of which dont really apply, and so its always that careful balance. Ultimately it comes down to how do we protect that child sitting in front of us to be sure that they are having the best experience, not just in sports, i mean, in clinic i see kids who are in the performing arts who fall off the stage, with he see kids who are just kids and they are injured falling down or in Motor Vehicle collisions. We want to make sure that the brain health of children for all reasons is taken care of and i do think that in five years, again, with funding that we can prioritize toward our youth we will have a better understanding. I dont think it will be the complete answer, but we will have a better understanding of some of these issues that will help us guide, protection and ultimately clinical management. Michael, do you have a thought on it . I do agree with jerry. I certainly that i that in five years we will be much farther along than we are today, but i dont think that we will have all of the answers in five years. I think were probably decades off, unfortunately, from a really full understanding, but in order to gain that understanding you need the research. So two things. One is that if you look at research in the area of concussion and brain injury, it is advancing exponentially. If you look at the number of studies in that field ten years ago compared to now, it is dramatically increased and will continue to increase, however, we need the data. We need those numbers. So its actually through apps such as the injure free and similar ways to collect the data. Its almost impossible to collect sufficient data without that in this day and age. Charlie, that goes to a question i had for you around Data Collection and analytics and big data nowadays with the cloud and the ability to really store and compare analytics. Youre starting to see some states that are doing well and youre seeing trends even between districts in sports and counties and School Systems. So there is a chance to create a little Competition Among our states and counties as to how theyre doing. Tell me, if you would, you mentioned minnesota, washington state, a few that are doing well at concussion education and prevention. Sure. Yeah. We see a lot of different trends. It is something that as dr. Gioia pointed out since 2009 all 50 states including washington, d. C. Enacted some sort of concussion law, many of them were modeled after the law in washington state. Then up until 2000 i believe, 14, the last state came on board. So those the legislation that was put in place there was set to be a standard and i think now many of the states are revisiting those standards and looking at, again, how they can en can compass not Just High School athletes, but also addressing the youth sports markets that are outside of the education world, but also then middle schools, Elementary Schools, you know, as we mentioned, kids falling off the performing arts stage, things along that nature. As we begin to address it, its a much larger issue. So there are a number of states that are trying to take active measures right now, university excuse me, the University Inter sclast i can league is the governing body for all High School Sports in texas and they are making a concerted effort to collect some information from their High School Athletic population on what information can we gather, how can we find medical researchers who will study this and help us make those decisions. As a etch could, as a former coach and an Athletic Director we never wanted to be the ones making those decisions, we wanted that advice coming from those that, you know, have the degrees to support the decisions being made. So it is a community effort, much like were seeing here in washington, d. C. Addressing total population, but many different stakeholders involved in this process and were seeing the states revisit those laws now. You know, the movie concussion was heart breaking and i think wil smith is up for a golden globe for his performance. Frank gifford this cte we found out around the holidays. Do you think the nfl has been more responsive on head trauma and targeting and some of the penalties associated with the penalties meaning sports scoring penalties related to head to head contact with these helmets and these hits, michael maybe. I certainly think that they are much more receptive now than previously. I think that they are certainly looking at and understanding the data that we do have as well. As gerry mentioned earlier we do have to be careful about overinterpreting the information that we have. So i think we do recognize that recurring concussions are a serious problem, but again, we see thousands of Football Players who have had recurrent concussions over the course of careers, many of whom dont develop it so we really need more data. Certainly they understand that we do need to look very carefully at the penalties and how we can protect the players, particularly if thats the primary cause of the later sequelae of the injury. Let me also say that, you know, the nfl you know, was definitely pushed into selfexamination but theyve also put money toward the nih, giving 30 million to study this problem. But i think going beyond football, what has happened is it is now really asking all sporting organizations to examine what theyre doing to really look at that risk reward balance and to make sure that how we are teaching kids in particular to play the game, how we are teaching officials to manage the game and then not unimportantly and probably maybe even number one, how we are trying to modify the culture, particularly parents and their focus and sometimes overfocus on sports and the outcome of the game, to really put injury prevention into perspective. So that the goal of the game is not always at the youth level, you know, to dominate your opponent. It is actually to do the best you can with hopefully the outcome of winning the game, but to take safety into perspective and to make sure that we are really managing this carefully. So i think this whole conversation, whether it starts with a concussion movie, what the nfl has done, what u. S. Soccer has put in place is really looking broadly and widely and really many other National Governing bodies. U. S. Lacrosse, u. S. A. Hockey have all been examining themselves, u. S. A. Rugby. I think its a good move going forward. What we ultimately need, quite honestly from the perspective not just myself, but really a Research Consortium that i work with, is we need a National Registry. We actually need with, you know, the possibility of using Something Like injure free, to be able to register kids into a system, be able to identify their injury and be able to say, what is the denominator of the problem, meaning the kids that are out there playing, whats really the numerator of the problem and to be able to say what is the percent likelihood that this particular sport is going to create this particular kind of injury situation and then back that up to say how can we prevent it . How can we make sure that we are maximizing reward over risk, benefit over cost . But we dont have that national database, that National Registry in order to make those decisions and fundamentally thats what we need to do. If we put into place in every state a system such as charlies to say, all whatever tens or hundreds of thousands of these athletes are now playing from the age of 5 through the age of 18 and we are providing education to all these coaches and parents, physicians, to schools and we now recognize and record the injuries that they have, we now can be able to say, this is happening in this way with this sport under these conditions. We can modify them in ways to reduce that risk, but weve got to have a fundamental database in order to let that happen. Yes. Can i follow up on that point, if you dont mind . In your opinion why isnt there a federal reporting standard . Is it a lack of will . I was asked a similar question by tom goldman a couple weeks ago and i said its about priorities and about funding, and the priorities have really been, you know, to look at the professionals, to look at the cleollegiate collegiates. The ncaa has a care grant that has multiple universities involved, they are developing data systems that are going to really help them to understand injuries, not just head injuries but all kinds of injuries. We need the same thing for youth, but again, the advocacy of that has been missing. I dont think its will in the sense of people believing that children are any less important, but i dont think weve had the voice behind this to really make it happen. But along with that we havent had the organized body like the ncaa and thats why were putting together this what we call the four Corners Consortium to youth sports and youth brain health to really try to garner that organizational system so we can put it in place. You mentioned that Congressional Committee that is going to be looking into this in 2106. As they take months to look into it hundreds of thousands of youth are still in sports. Do we have time to waste . Well, we dont have time ever to wait for a youngster to be injured. Again, as i said, we want our best policy to be based on our best evidence. We have some interim tasks in between that, but weve got to move the priorities toward our youth. You know that fred uptons committee on house energy and commerce was the one for 21st century cures and that legislation was passed in the house last year which largely went to medical devices and other kinds of breakthroughs was the subchapter, breakthroughs that can get to market better to help patients. Concussions wasnt included in that and i think maybe fred and the folks on that committee are trying to bring that into the fold of 21st century. Charlie, do you have some thoughts . Absolutely. To follow that point, what we are seeing is a lot of the School Districts themselves or organized bodies, the National Governing bodies for sports are taking these actions without that pressure, without that funding theyre finding ways to make these changes happen. It isnt universal but theyre doing what they can for their populations. Many of the School Districts that we work with on a larger level are taking these types of actions to create these environments just like jerry is describing where theyre collecting information and a lot of this is driven from a Liability Protection standpoint, but at the same point it is very much a lets get as much information as we can, lets put it in the hands of medical researchers, of caregivers who have the credentials to oversee this population and then put the changes into place, what they can do with that data and how they can identify. Concussions may not be the number one injury for all athletic sports in the country. There may be field conditions, there may be footwear issues, there may be pre stretching or pre warming up techniques that need to be modified but certainly thats the driver and thats what were seeing from the School Districts now and some of the youth organizations that are involved throughout the country. That theyre taking steps on their own without that support, without that funding mandate behind that. I had one other question on helmets. 475 rydell helmets with sensors with them. Sensors measure impact, they measure the impact of the hit but they dont necessarily say whats going on in the brain and the brain exists in its own liquid, i guess, has its own surroundings and its not something thats measured internally, its an external. I guess i have a question on helmets and whether centers can help. Michael, if you could start. So i believe that its highly likely that they can help. At this point in time the challenge with the sensors is we dont know what the thresholds are. So we need to have a lot more research around that and then there are different ways of measuring even with the sensors whether youre measuring a Rotational Force versus an impact and those may have different factors as well in terms of the likelihood of developing a concussion. I do think that theres Great Potential for sensors, i think right now the clinical use of sensor or the use of sensors in Standard Practice is premature and i think gives actually in some ways a false sense of security versus an appropriate diagnostic tool. I will tell you about a study that were doing at wake forest that is looking at youth football in which we have sensors in the helmets, but what were doing is we are evaluating the function of children ahead of the season, we are actually doing very specialized mri and they specialized eeg scans of their brain and then were doing that at the end of the season and were tying together the biomechanical information that we learn from the sensors with that functional and brain outcome. Now, were doing that longitudinally as well over a number of years to see what are the effects of this you know, basically the forces. I agree 100 with what michael said. Our sensors at this point are not ready for clinical prime time. They are still a Research Tool and there has been a lot of study by some of my colleagues really at the professional, at the collegiate level trying to understand just the science of sensors. How you place them, how they register information, screening out the false information from the real information, what we call the signal noise ratio. Think about putting a sensor not just in a helmet but on a head maybe on a band on a fiveyearold out there playing whatever sport, versus a 25yearold in a helmet, its a very different situation. So a sensor is not a sensor is not a sensor, but the biomechanical information that it has the potential of offering us tied to brain function and really cognitive and physical function i think is going to play an important role. I dont mean to hog if everybody else has questions. Can i ask you, dr. Yochelson, it sounds like what youre talking about in the d. C. Area is flooding the zone with information and measuring and whatnot. Very simply what is your goal . So, again, the goal is really to understand in a variety of different ways what is going to lead to clinical problems in the present and in the future for any individual. So without data, whether youre talking about sensors, whether youre talking about number of concussions and frequency of concussions, rate now we really sort of use the data that we have or the information that we have to guide our clinical decisions, but theres a paucity of that. So as a clinician i need the research, i need these numbers to then come back and say, okay, based on what has happened to you as an individual student athlete, this is what you should do. Should you go back into the game, should you go back to school, are there any medication thats another thing, too, we havent touched on at all, but are there other treatments, particularly if there are any biologic or genetic predispositions to this. Are there other ways that we can help to either protect against or treat a concussion once it has occurred. Were far from understanding that, but it is a possibility. Is your goal to prevent concussions or save lives or both . Well, i would say its certainly both. I think that ideally the prevention is what you want to do first, but youre never ever going to prevent 100 of concussions so you also want to understand how you prevent the chronic longterm effects and save lives. Let me just add that really also in addition to what michael is talking about our goal is to maximize the three Core Principles of the law. Number one, to maximize the recognition of a suspected injury to the brain. Number two, to then act on that and remove that player from risk. And then number three, to make sure that they are allowed that appropriate recovery so that they are not going back into harms way when that brain still in a vulnerable state. Again, my good friend stan herring has said, you know, when you go out to dinner tonight, whether it be one of your parents, your spouse, your friends and they start to sweat profusely and they start to grab their chest and breathe heavily, you are not a cardiologist, but you are not going to sit there and just let them do that. Youre going to do what weve all been trained to do, call 911. Because you want somebody to look at this individual. Thats what we want for concussion, is the 911 of concussion, where we recognize the conditions for when we remove somebody from a highly risky situation. And so weve got to educate folks because we know that there are not medical professionals on the sideline at most sports for kids under 18. And so we need to prepare the systems and the responsible individuals for making that 911 call so to speak. So the question on policy is one about compliance and whether that requires a mandate or not, we dont know yet, the states have the laws on the books and some are more progressive, sadly it often takes an injury and a parent and a lobbyist on the state capital grounds to make these things happen. Wtop. Charlie, can you talk more about this Apps Technology and how it would be applied in a real life situation. A kid gets a hard hit on the football field, who brings up this app . How does the information get put into that app . And also how do the doctors come into this . How does this get tracked from recognizing to treating . Absolutely. So, again, to follow jerrys points about what the grant and the program itself was put into place, the first portion of this is the distribution of concussion Education Training, making sure that coaches, parents and students are going through whats required for them for participation. Either as, again, a coach, an employee, a staff member, a volunteer or as a parent in a child before participation. Just awareness, signs, and those types of things and thats being satisfied through a number of different platforms that have been uploaded into our system so we are not building those Education Trainings, those are being done by the medical professionals and the cdc and we deploy that and then register thats been accomplished. The administrators for those organizations are able to check off, run through a roster list so that a coach before a game can actually bring up on his or her smartphone a list of students if they have gone through those required Education Trainings their names will be in black, if not their names will be in red. So they will know who has and has not been cleared to play. If there is then one of those children are participating, there is a suspected concussion, again, a coach, there is no medical professional on the sideline, a coach, a parent, someone who has been trained to use the application or has been authorized to access by the participating organization is able to bring up a simple Injury Report process, just drop down menus, asking basic information. We are not asking them to do any type of diagnosis, but we are asking them to enter any signs or symptoms they may have of, you know, whats going on in front of them to that potential injury. At that point, then, that information is available for the administrators at the organization and the parents of the child, the coach of that particular team, anybody else, again, who has been authorized. A part of the process is to alert for children for the doctors and medical professionals at medstar and for childrens to be able to have access to that information so that if a parent needs to come in for a suspected concussion evaluation they can bring up the doctors that they come see will be able to pull up that information with that parent access, with that parent authorization. They will be able to provide an evaluation and designate, yes, they do have a concussion, no, they do not. And that medical clearance process. If they do they go into the standard return to play protocols that are outlined for the Recovery Process at which point at some point hopefully they do recover and then those medical professionals are going to be able to make that designation inside the platform. Again, that name is going to go from red to black and the coach can bring it up on their side line, yes, youre cleared, no, you are not for that participation. So any coach coaching would have authorization to this app . It depends on the organizations. So when we talk about, say, stoddard soccer or any one of the high schools here, st. Al bans, for example, it depends on how that administration deploys their app, if they want the coaches to be able to have that access for injuring reporting, for read only access, its customizable in that sense. We may want to talk about how youre going to be tying the concussion recognition response app into this. Right. So, you know, there are really two levels of how we make that information available. You know, charlie has built a system for athletic trainers, for Team Physicians to be able to go through and do their assessment, their clinical medically educated clinical assessment, but again, probably 90 plus percent of the time we dont have that person on the sideline. So we go through what we developed with our cdc materials, which is the concussion recognition and response app for parents and coaches that were going to tie into the system that allows them to go through and literally identify the incident and record that information, to give them just a simple yes, take the kid off the field, no it doesnt appear like they need to be off the field right now. Give them some guidance with what we have trained them ahead of time to understand, but i dont know about you, but if im taught something one day, three weeks later im going to be asking myself how am i going to remember what im looking for. Well, theres an app for that to remind you of the questions you ask, you can record that information, have that registered in the system and made available now as you pull that youngster off the field and going to the medical professional now to decide whether it is or is not diagnosed. When we looked at the community and the eco system that exists in this process, theres a lot of information gaps and it was about collecting as much information as we possibly can from whoever is on site, giving them the right tools to be able to do that and then passing that information aggregating it and allowing a medical professional then to review that to help with the process. Like dr. Yochelson was saying, we want them to be able to look through all the information they can and make the right clinical decision. So its that connected Care Community that were trying to create here by allowing these types of pieces of evaluations to be accessible by authorized administrators. So, again, there is a specific scad evaluations, standard concussion evaluation tool for athletic trainers on its sideline, but if there are no trainer is Something Like the crr would be able for the parents to go through some recognition process. You might be able to go into the app store and download this app no matter who you are. It would have to be through an authorized person or School System would authorize you to have access to this app . Correct. It is not a standalone, it is part of an eco system that is deployed by the governing organization here in washington. Its been made available for every youth sport and youth Athletic Organization across the board, all schools, element he ri, middle school or high school as well. It is available for those organizations, we are deploying it right now, we start our department of parks and rec deployment coming out next we can, it is rolling out through washington, d. C. As we speak. What about virginia and maryland . We have talked with the virginia board of education on friday, right. On friday. An who will ton the secretary of education, it would be deployed through the state boards of education and National Association of state boards of education are talking about which states might be most appropriate and letting those education departments the does, department of ed of the states are the governing authority and the department of health. We are speaking with the Maryland State Youth Soccer Association as we talked about what theyre doing on their own without the state push or in lieu of until we wait for those pushes to come. Organizations that are forward thinking that are being proactive that are working with some of the researchers here at medstar and childrens also and taking that guidance and putting their best foot forward for their parents and families. This rollout is happening right now in d. C. Schools. When do you think it will be completed for all schools or all schools who want to participate . Our goal is by the start of next school year. Many of the again, i mentioned the department of parks and recreation, that can occur at any time and that rollout will continue to occur throughout the year 2016. But when it comes to the school year, we will get as many as we can done before the summer, but certainly by football season coming up in 2016 we want to make sure we can get as much as we can covered in that process. And injury free is in la jolla, california, and you have a lot of good scientists and docs available to you there as well. I think you told me before the event that u. S. A. Soccer and u. S. A. Lacrosse are taking some bold steps as well, its not just football. That those sports organizations are starting to work on data analysis. Gerry hit it on the head, too, with the type of populations that are involved much of the focus has been football and at the professional adult level or high collegiate level. I have two daughters so what about female athletes . We want to make sure there is a standard level of care for all students or youth participants in athletics and thats being accomplished. So we are working with a lot of the National Governing bodies who are very proactive. U. S. A. Rugby is one were talking about, u. S. Diving theyre talking about updating their concussion education requirements. Some so of the sports that you might not necessarily think about but certainly the ones that are underfunded that need extra support, they dont have the manpower or funding to be able to deploy massive concussion Education Training programs, we want to be able to provide them the technology thats going to allow them to amplify those efforts and take some of the best minds in the country here on this issue and amplify their efforts as broad as we can. Thats the purpose of technology, right, so that theres not always necessarily that Human Element involved, we can amplify that goal. I want to thank our speakers and presenters today here at the National Press Club Newsmaker committee for this very informative session. We will see what the house energy and commerce committee, the youth sports caucus and various state capitals do with concussion as we move forward into the legislative session. A couple of quick resources on the website Childrens National. Com you can find play smart, your brain matters, the concussion Awareness Training program is at the childrens site, injure free. Com, medstar and were excited to be able on the National Press club, press. Org with some Coverage Later today. We want to thank cspan, cbs news, wtop and ewn for covering today and we look forward to your reporting and we are adjourned. Thank you. Live Coverage Later today on cspan 3 with a Bipartisan Task force to combat the heroin epidemic holding a hearing to look into how the drug is being abused in america. We have it live at 2 00 p. M. Eastern. Later former defense secretaries from the obama and clinton administrations on the state of u. S. china relations. Thats live at 5 00 p. M. Eastern here on cspan 3. Members of the congress, i have the great pleasure, the high privilege and the great honor of presenting to you the president of the united states. [ applause ] im don ritchie, im a senate historian. The state of the Union Messages mandated b