The district of columbia state athletic association. And we have randy trivers. He is the head football coats at Gonzaga College high school. National coach of the year in 2018. He has coached football for 28 years and was derek sheelys coach. Thank you for being here. Similar to what we did with the last panel, we want to go down the line, what is one area and best practice when it comes to High School Football that has improved . What is an area where we need more attention . Can speak morei specifically to my experience as opposed to overall in High School Football. I do have many colleagues and folks that i have been paying attention to. Earlier, the amount of time allocated towards full contact is certainly changed over the years. The protocol in terms of recognition of injuries , and return to play with regard to head injuries and other injuries. Structure and it is more sophisticated now than it has been. That, theelative to communication between athletic trainers, and coaches with regard to return to play, and schools, academically. I think those are areas where i have seen improvements in my experience. Jon anything that you think needs more attention . Randy i think continued overall, everybody, when it comes to the coaches, andplayers, the parents, continuing to have these discussions. Continuing to communicate and educate is vital. Jon jennifer . Jennifer one of the greatest improvements is the National Dialogue around safety, although concussions or heat illness are not the only problem we have. The more we have discussions, the more knowledge, education, and people we reach. Unfortunately, the reasons for those National Discussions are tragic, and should have been avoided. We should have never gotten to that point. I think what we need to improve on is there should not be a question of whether or not an athletic trainer is a worthwhile investment, or should be there. Why are to have new uniforms more important than an athletic trainer . Why is a sled more important than an athletic trainer . Through a large initiative we finally just got aeds in schools in the last few years, it should not have ever taken that long. Jon any thoughts of what has improved or what needs to improve . What they said, putting the information out there, and informing the players so they know what to look for, and when they need to get help, or when they need to help their friends. Jon i think that is really important. I wanted to talk first about Emergency Action plans. Jennifer, that is so important to any sport, but particularly football. It is not that you have an Emergency Action plan, that it needs to be real horst rehearsed. The weight room has a different Emergency Action plan than the stadium. How often should it be rehearsed . Coty emergency jennifer emergency access plans should be venue specific and sensitive to the time. A gate we use for an ambulance for football has to alter during anecoming because parking is issue. I alter that gate. Z who has the keys, are the gates functioning . Checkked thoug i those before every game. Working, gates are not rusted shut. At my high school, we are two blocks off of the d. C. Maryland line. If i get 911, i get pg county. In my action plan the first thing you have to do is to be transferred to d. C. Ems so you do not waste time in pg county is not trying to figure out where you are. It needs to have the location of emergency equipment and what is there. Do not want people wasting time looking for something not even there. The personnel is that you will need to contact. If it is my Athletic Director that will open the gate, is he available or will he be handling something at the concession stand or ticket booth. Bible of whatz you need to know in the worst possible scenario and it needs to be clear because the people will be nervous and they will not be focused on the little details. It just needs to spell those out so they do not have to put thought into it and they can go down the line. We practice that at least once a season. Your coaching changes and staff changes, any changes that come about. If you get a new coach, and it needs to be rehearsed and Everybody Needs to know what their role is. Jon what does rehearsal look like . Do you pretend that there is a real emergency . Jennifer absolutely. Sometimes i will tell my coaches and sometimes i will tell the kid to fake an injury and clearly once we get into it the coach knows that we are not really. The first couple of minutes they did not know that so i need to know that they will respond. Handleaches do not malformed body parts well, some coaches do not handle blood well. Those are not the coaches you need on the field by your side when something is happening. You need to coach that will help you with crowd control, the coach that will keep the team away, the coach that will be levelheaded and will direct people to do you need them to do. Approach withour Emergency Action plans . Randy i think jennifer hit on something important. It is always under poise under pressure. The word i do not know if the word is catastrophic, but something not in your normal, everyday practice or game situation when somebody comes up with a severe injury. From a high school coachs perspective as a leader to maintain a certain sense of pose, poise, because a lot of the people and the environment will base will react based on how you react. The athletic trainers are very aware of that as well. Everybody is looking to those people in these situations for guidance and leadership. Is asnk something simple as just in those leadership position taking the right steps to make sure that you go through what is necessary to solve whatever the problem may be. Jon we are trying to identify best practices, where do you guys keep your Emergency Action plans . Do you have tips for the best place and where the most number of people can see it . Jennifer immediately assessable. Some athlete trainers may clip it to the water coolers, tape it to the tables, in the aed cabinet, i give it the coaches at the beginning of the season. Wherever it is easily accessible. Jennifer emergency medical randy in our emergency medical kids, sometimes there or we have binders in our carry bags and so forth. Those are some of the different we will have our plans in case of emergency. Of course, todays Technology Makes it a little bit different. The cell phone certainly is very helpful. When it comes to the old days of trying to run in and get to a payphone or get to an office where the cell phone has made things a little more accessible. About best practices for heat illness and how to deal with that. What used to be done and what are some of the biggest mistakes that you see . Jennifer the very first is not cooling them. Essential,critical, we have had two local cases that have highlighted that more than adequately. Towson, they removed him from the cooling bath and he ended up having to have a liver transplant. Had they kept him in the cooling tub, he would not have had to have the liver transplant. Those are things, that is all i say to my coaches, cool first. There are no medical conditions that you are going to worsen by the cooling itself. If you are not sure, cool them. Then, there are things that can be worsened by the delay, so you need to activate ems. If it is a diabetic situation, cooling will not hurt the athlete, but you need to initiate the proper care for diabetes. Mimic other can symptoms and conditions, so when in doubt, the number one way to help manage exertional heat illness is old thermometer eat, that has been a big topic among High School Athletic trainers about privacy and that they are minors. Where,oming to a point just like when you do cpr, you will break ribs. You assume that the person would rather have broken ribs than the alternative. Now we are trying to take the approach that they would rather we know and not transfer them. An airconditioned ambulance is not enough to reduce the damage, so we need to keep them in a cooling tub until they get down to 102 and then transfer them. Juste trying to make that as commonplace that we would rather we think we would rather die she would rather we know and deal with a rectal thermometer and then rather than not know. Jon let us talk about Concussion Management and protocol. I just want you to share your story a little bit from a players experience. Youve been playing football since third grade . How many concussions . Coty i have had eight total. Jon all football . Nonsport related, and four from football. Jon how old were you when you were first diagnosed . Coty seventh grade. Jon describe what are the symptoms like, and did you notice that you possibly that you possibly had a concussion . , iy as soon as i got hit fell to the ground and i blacked out. Up, just a few just could not remember what happened. I couldnt really remember anything. Jon that was my that was your first one . What did you notice on other ones . Ones, i started when ice less and less would suffer a concussion. Themse, i did not get actually treated until about two months ago, when i actually did something for them. It, you are playing through because you were not aware or because you just wanted to keep playing and you did not want to get off the field . It was more so that i was not aware, and i did not realize, because i was not given a lot of information. About twofinally months ago my mom said she asked me if i had ever had a concussion and i thought back and realized that i had a lot of them and i just played through all of them. Common. T can be kind of jennifer very. They are highly motivated to stay on the field, both for intrinsic and extrinsic reasons. They do not want to be perceived as weak or it not being able to do what they have agreed to do for their team. I preach to the kids how important it is that they be honest with me. I show them videos of athletes that have suffered longterm consequences, which admittedly scares them into hopefully being more honest with me. D. C. Is thatn athlete trainers have a lot of autonomy. We practice the medical model and that we do not report to any athletic personnel. There is no part of my job that is dependent on the outcome of any athletic event, so i can stand my ground. If a coach or an overeager parent, or anyone else disagrees all i have to do is medically dq them, and that is the end of it. That is not true everywhere. That medical model needs to be pushed. They mentioned it in the last panel, that is critical. If i am afraid of losing my job, then mi always going to make the decision that i need to make then am i going to make the decision that i need to make . Neurologyent to a clinic in minnesota . Were they able to help you . Two monthst there ago, and they told me that i had istconcussion syndrome, and told them all of my symptoms, because i took some time to think about it, and what i have been going through. Jon is it helping . Coty tremendously. Jon i saw that you posted on twitter a couple months ago that because of the concussions you are going to stop playing football and not try to go on to college. You have changed your mind a little bit . Where are you with that . Because myundecided neurologist has not cleared me to go back to full Contact Sports yet. Jon what is your hope, do you hope to keep playing . Coty i just hope that i can do Contact Sports of any kind again. Jon you mentioned not having a lot of education about concussions, what did you know and what did your high schools provide for your four years there . They just mostly gave us a. Aseline test each season from there we were told to not , and we were taught the right techniques. As far as symptoms and the feeling of a concussion, we were not told much. Jon what would have helped . Coty being told what the symptoms of a concussion are. Jon what is your approach in terms of how to educate players and what symptoms are . Randy most importantly is trying to create a culture where , andnication is immediate comfortable, and open. Of you may have to, in the short term, make a small sacrifice, as far as perhaps being out of practice or a game as opposed to not communicating, and then the situation has longterm effects. Whether we are talking about notussion or an angle, reporting the injury in a timely manner often ends up being worse in the long run. I think the athletes and coaches, and the Training Staff having great communication consistently with regards to whatever the injuries are. It goes along in really helping everyone. The athletes want to play and to or where field, court, it is. They want to to zepeda. Sometimes athletes they want to participate. Athletes do not communicate because they want to play. Create aying to culture where it is understood to communicate whatever your injuries may be in a timely manner and honestly, so that the experts, the folks like jennifer can help these young men and young ladies get back to doing what they really want to do. Jon what education materials do you try to provide coaches . What do you think high school aged players need to know . Most states we require parental notification of the signs and symptoms of a concussion, they sign off on a form the athlete has to sign it as well. We hope they read it before they sign it and it has the signs and symptoms and what to look for. Thecoaches have to take. Oncussion awareness video we ran into the first couple of years they thought they knew as much as i did about concussions so they did not need to come and find me when they had an athlete that had sustained a concussion, we had to revisit that at the coaching meeting. , they sickly, making basically, making them aware of what a concussion is, that two concussions will not be the same. It may be as subtle as you cannot see sleep very well anymore and those things need to be reported when you are concerned. To be reporteded when there is a suspect suspected head collision or that it does not always take a head collision. It is not just a direct blow to the head that can cause a concussion. Like i said, i show them videos and we usually take trips to ohio and i have a seven hour captive audience and my coaches are very cooperative in letting me show them videos to let them know what they need to be looking for. The buddy system helps a lot. I will have a kid come to me and say such in such is not acting right, and that helps a lot too. Jon coty mentioned baseline testing, that is a controversial even about whether that is effective. You do a baseline tests and then compare it to a few things if there are symptoms later. Pros,r mind, what are the and cons, and doesnt have value . Jennifer i think it has value as a tool but not as an end all be all. Resources. At they anecdotally do not necessarily feel it is completely necessary for them to have baseline scores when they are evaluating or treating. Tool, itso be a good data for me toe show my coach. Or kid isoaches getting antsy, i can use that to my advantage and say look, you are not quite back to where you were, so it is one more thing that takes it away from them thinking that it is my opinion. Concussions are more difficult than a lot of things because you cannot see a concussion, you cannot see the swelling, a bruise, there is no lack of function in a joint. , evena little harder athletes when their symptoms linger, then that is when it becomes a bigger problem. It is hard for them to prove that they are still symptomatic. That is what we work on, making sure that they do not have to prove anything, a big part of that is returned to learn, it is hard for them to hide cognitive issues in the classroom. That should be an imperative part. If they are not meeting the academic rigors and athletics should not be part of the equation at all. They have to do cognitive work first. Jon how often do you use baseline . Jennifer every two years, when they come in as freshmen and then again as a jr. A junior. Have any reason to suspect concussion, then that is not a baseline, that is when we do post injury. We do not do them right away, we let them do healing first. We do them usually twice in their high school career. Jon let us talk about hitting limits. Overview,ve a brief what does a week of practice look like, how much contact do you have . Randy i heard some of the gentlemen talk about different modes of contact in practice as far as so for us, we have a different test a tempo. Tag,ave a walkthrough, a moving at a good speed but no content contact. We have a tempo which is contact with blocking and different contact with note to the ground contact. Which isa live tempo what you would execute in a game. Season is pretty rare that we do live tempo. Us,ling to the ground for we would do more a combination of the first three, live tempo if we did during a game week it would probably be anywhere from three to six plays over the course of a week that we would once we sometimes zero get into the season. Most of our life contact would be done in preseason Training Camp leading up to the season with scrimmages and some practice. Once we get into the season, we do not do, it is very rare that we do any live work. Jon can you estimate how may minutes a week . Nifer less randy less than five minutes. Debate, people say that you have got to do live to still get the feeling of football and the physicality of it. Do you lose anything . Less there is a phrase, is more. That we thinkngs is that more is more, i have to lift weights seven days a week for seven hours a day. More is more. Diet, sot to eat, or sometimes what you do in moderation allows you to sustain and be better long term. The idea that we feel that we can get an awful lot out of the way we practice without putting the players at risk. Certainly a balance you must have to prepare them for alsoigors of the game, but overtraining,rt, or overexposed. The athletes want to play, that is what they want. How can we prepare them in a way of the a way that they are able to do that efficiently, but consistently in terms of their ability . Ask about our performance, i think we perform well with limited live repetitions, there are many other ways to prepare the player for the contest outside of live tackling and drills to the ground. Jon what other ways . Courseit is over the of a practice or a practice day, some of it is in classroom, it is learning by watching the videotape, some of it is going to be walking through, some of it is going to be noncontact drill work or animal contact. It is a combination more minimal contact, that is a combination that will allow the players to play well and fast. We believe in playing smart. We will say guys, above the neck, we want to be really good as far as how we player how we play and plan. , wet of it is mental b