Defensive lineman and played only for vikings as a senior in 2018 in part because of the concussion. Coty has spoken public about his Mental Health struggles in an effort to raise awareness about depression. Next to coty is jennifer rheeling, she sent her 20th year as an athletic trainer in washington, d. C. Public School System where she works at Woodson High School purchasers of Sports MedicineAdvisory Committee for the National Federation of State High School associations come National AthleticTrainers Association and the District Of Columbia state athletic association. And we have randy trivers, head football coach at Gonzaga College high school in washington, d. C. Who last you when the schools first athletic conference title since 2002. He was named usa todays National Coach of the year in 2018. He has coached football for 23 years and was coach at Northwest High School in germantown, maryland. Thank you all for being here. First so much what we did with last panel. You quickly want to go down the line start first with you randy. What is one area, one best practice when it comes to High School Football health that you think has improved the last five to ten years and whats an area where you think we still need more attention . I think i can speak more specifically to my experience as opposed to overall High School Football. However, i do have many colleagues and folks are paying attention to but i would say as part of earlier i think the amount of time allocated towards full contact i think is certainly changed over the years. I think also the protocol in terms of recognition of injuries and return to play with regard to head injuries as well as other injuries is more structured, more sophisticated now than its ever been. And i think relative to that, the communication between athletic trainers and coaches with regard to return to play and schools academically, i think those are areas that i think ive seen improvements in my experience. Anything that you think needs more attention . I think just continued education, everybody overall. When it comes to the coaches, the players and parents, just continue to have these discussions, continue to make it and educate i think is vital. Jennifer, how about you . I think one of the greatest improvements is the National Dialogue around safety, although concussions or heat illness are not the answer or the only problem we have. The more we have discussion, then the more knowledge and education and the more 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 mac. And i think what we need to improve on is it shouldnt be a question of whether or not an athletic trainer im selfserving whether or not an athletic trainer is a worthwhile investment or should be there if you have to have, what our new uniforms more important than having an athletic trainer . What is a sled more important than having an athletic trainer . Even here in d. C. Public schools to a large initiative of the department of athletics we finally just got aed in the school in the last two years. It should have never taken that long. Coty, any thoughts of whats improved what needs to improve . Just like they said, just putting the information out there and really 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. I think thats really important. Want to talk first about Emergency Action plans. Jennifer, thats so important, really any sport but particularly football. Not just fetch up Emergency Action plans but it is rehearsed in different venues. The weight room has a much different Emergency Action plan than a football stadium. What should be an Emergency Action plan and how often should it be rehearsed . Emergency action plans must be venue specific. They must also be sensitive to the time. The gate we use for and interest for football has to alter great homecoming because we have a much larger crowd in parking is more of an issue. I alter that gate so that the andrews has more direct access. A to z, who has the keys . Obligates all functioning . I checked those before every single game to make sure every gate is functioning, they keys working to know what has changed the law. The lock has a rusted shut, any of that thing, any of those things. Where at my high school we are two blocks of the d. C. Maryland line. If i down 911 i get pg county ems to her in my action plan the first thing you have to do it has to be transferred to d. C. Ems so you dont waste time going through that and pg can is and can fit where you are. It needs to have the location of all your emergency equipment. Whats their piccola people wasting time looking for those things and looking for something thats not even there in existence. So who the person allies that youre going to need to contact, if its my Athletic Directors going to open the gate is my Athletic Director failed or is he going to be handling something ethic concession stand at the ticket booth . Its a to z bible of what you need to know in the worst possible scenario and a needs to be clear because those people are going to be nervous and theyre not going to be focused on the little details. It just needs to spell those out so they dont have to put thought into it and they can just go down the line. We optimally practiced at least once a season. Your coaching changes, your Coaching Staff changes, any changes that come about. If you get a new coach, then it needs to be rehearsed. Everybody needs to him what the role is in the Emergency Action plan. Do you pretend theres a real emergency and now home, pulled in action . Absolutely. Sometimes ill tell my coaches and sometimes i want. Sometimes i will tell a kid to fake an injury include once we get into at the coach knows that now were not really, but the first couple of minutes they didnt know that and i need to know theyre going to respond. Some coaches dont handle malformed body parts will pick some coaches dont handle blood well. You dont want those coaches come out on the field with you. Those are not the coaches you need by your side when something is happening. You need the coach that can help you with crowd control. You need to coach thats going to keep the team away. You need to coach thats going be levelheaded and contract people to do what you need them to do. Randy, whats your approach to the Emergency Action plan after school . Really the employees under a pressure situation. I dont know if the word is catastrophic but certainly something that is not in your normal everyday practice or game situation coming up with a severe injury. And i think its important from a High School Coaches perspective as a leader to maintain a certain sense of poise, because everybody, when i said everybody, a lot of people and environment will react based on how you respond and react. I think the athletic trainers are very aware of that as well. Everybody is looking to this people in these situations for guidance, for leadership. I think something as simple as just in the leadership positions being poised and taking the right steps to make sure that you go through what is necessary to solve whatever the problem may be. Try to identify best practices. Where do you guys whats the best place people go that you know they are there . Jennifer, where do you speak is where it will be immediately accessible. Some athletic trainers may clip it to the water coolers, tape them to the tables. In the aed cabinet i give my coaches a copy at the beginning of their season, wherever its going to be easily accessible and available. Rady, do you know where you guys emergency medical kits or we have binders, terry backs and so forth. Those are some of different areas where we went as will have hours, plans in the case of an emergency. Todays Technology Makes things different than it was years ago. Cell phone certainly is very, very helpful when it comes to the old days of trying to get to a pay phone or get to an office where the cell phone certainly has made things more accessible. Jennifer, how about best practices about how to deal with that and what needs to be done and maybe what are some of the biggest mistakes that you see when a player is overheated . The very first mistake people make is not cooling them first. Cooling is critical. Holy is essential. We have had two local cases that have highlighted that more than adequately. Gavin, the removed them from the coating bath to critique and ended up having to have a liver transplant. Had they kept it in the cooling tub until he got down to 100 you he probably would not have had to have that liver transplant. And for the jordan last year had a completely different outcome and was not apparently managed as well as we wouldve liked for him to be. So those are things thats all i say to my coaches, cool first, cool first, cool first. There are no medical conditions that youre going to worsen by the cooling itself. If youre not sure, cool them, and then there are things that could be worsened by the delay so you also need to then activate ems. If its a diabetic situation. Cooling is not going to hurt the athlete budget also need to initiate the proper care for the diabetes. So he exertional heat illness can mimic many other symptoms, many other conditions. When in doubt of course the number one way to help manage exertional heat illness is rectal thermometry. Thats been a big topic especially amongst High School Athletic trainers about privacy and they are minors. But its now coming to a point where just like when you do cpr youre going to break ribs. Use of the person would rather have broken ribs and live in that intact ribs and the alternative. So now we are trying to take the approach that they would rather we know and not transfer them, and her condition and ghost cool enough to reduce the damage that exertional heat illness is doing. We need to keep them on site and in the cooling tub until they get down to 102 and then transport them. We are trying to make that just as commonplace, that we would rather we think we know when you got down to 10000 you and deal with the rectal thermometer rather than not do it and not know and not take the appropriate action. Talk about Concussion Management and concussion protocol for coty, i just want you to share your story a little bit. You told me you can play football since third grade, is that right . How many concussions . Ifad eight total concussions. All football . Four nonsport related and four football. Thats a lot. How old were you when you were first diagnosed . Seventhgrade. Just describe what are the symptoms . Did you notice you possibly had a concussion . For me that was probably my worst concussion come as soon as i get hit i fell to the ground. I blacked out. When i woke up i couldnt remember what happened. I couldnt remember really anything. That was your first one. U. N. Multiple ones as well what did you notice in the others . My other ones i started to notice less and less when i would suffer a concussion. Because i didnt get them actually treated until about two months ago when i actually did some for the. You were playing through it. Were you not aware or playing through it because you just wanted to keep playing and you didnt want to get off the field . It was more so i wasnt aware. You know, i just didnt realize, because i wasnt given the right information. And then finally about two months ago my mom said, asked me if i ever had a concussion. And i thought back and i just realized i had a lot of them. I just played through all of the. Jennifer, that can be kind of common, isnt it come for players . Very common. They are highly motivated to stay on the field, both for intrinsic reasons and extrinsic reasons. They dont want anybody else to perceive them as being weak or letting their team down, you know, or not being able to do what theyve agreed to do for 13. I preached to the kids how important it is that they be honest with me. I show the videos of athletes that have suffered longterm consequences, which admittedly scares them into hopefully being more honest with me. And a big thing in d. C. That is helped us is the athletic trainers have a lot of autonomy. We do not report. We practice the medical mart and we do not report any of the athletic personnel. There is no part of my job that is dependent on the outcome of any athletic event, and so i can stand my ground. If a coach or an overeager parent or anyone else disagrees with me, ill have to do is turn to the official and medically disqualified them and thats the end of it. Thats not to everywhere and that medical model is what really needs to be pushed. They mention it down the last panel but thats critical. If im afraid of my job or losing my job, then a always going to make the decision that i need to make for my patient . Coty, you went to a neurology clinic in minnesota recently, is that right . What did they tell you . Was able to help you at all . I went there two months ago, and they told me that i had postconcussion syndrome. And i just told them all my symptoms, because i took some time to think about it and what i have been going through your. Is it helping . Yes, tremendously. Good. You put on twitter, isil because of the concussions you stop playing football and now youre going to try to going to college. Understand you changed your mind a little bit, is that right . Where are you with that . I have not decided because my neurologist hasnt cleared me to go back to full Contact Sports yet. What is your hope . Do you want to keep on playing . I just hope i can do Contact Sports of any kind. You mentioned that having a lot of education about concussions. What did you know . What did your high school provide in your three or four years of there . They just, they mostly, they gave us a baseline test each season. And then from there we were told to not tackle with our head. We were taught the right techniques to tackle, but as far as like symptoms and a feeling of concussion, we were not told very much. What would have helped . Symptoms, being told what e symptoms of a concussion are. Randy, whats your approach in terms of trying to how how to educate players and what the symptoms are . Most important is trading, trying to create a culture where communication is immediate and comfortable and open with the athletes, and an understanding that you may have in the shortterm make a small sacrifice as far as perhaps being out of practice or two or gain, as opposed to not communicating and in a situation have longterm effects. So i think whether were talking a concussion or an ankle, not reporting that injury in a timely manner often ends up being worse in the long run. I think the athletes and the coaches, the Training Staff just having great communication consistently with regard to what the injuries are, i think goes a long way in really helping everybody get what you want. The athletes would want to play. They want to be on the field, there want to be on the court, on the ice, whatever it is. They want to participate, which as was alluded to earlier, sometimes athletes dont comedic it because whatever the pressures they are feeling externally or internally, whatever they are, i want to play, well, create a culture where its understood communicate whatever your ailment, injuries may be in a timely manner now, 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. Of a concussion, they sign off on a cdc form, we hope that they actually read it before they insign it. And it does, indeed, have the signs and symptoms and what to look for. The coaches have to take the concussion awareness video. We did run into the first couple years they then thought they knew as much as i did about concussion, and so they didnt need to come find me when they thought an athlete had sustained a concussion. So we had to revisit that with them at coaches meetings. But basically, just making them very aware of what a concussion is, that no two concussions are the same, that your own two concussions wont be the same. It may be as subtle as you cant sleep very well anymore, and all those things need to be reported when your concerned about whats going on. Theres any change after a suspected, you know, head collision. Or that it doesnt always take a head collision, that its not just, its not just a direct blow to the head that can cause a concussion. So, like i said, i show them videos, we usually take trips to ohio, and ive got a sevenhour captive audience. And my coach is very cooperative in letting me show them, you know, videos to let them know what they need to be looking for. The buddy system helps a lot. I frequently will have a kid come to me and say, hey, such and such isnt acting right in the huddle, can you check him out. So that helps a lot too. Jennifer, we alluded to it a little bit earlier, we mentioned baseline testing. Thats a little bit of a controversial topic, right, about whether thats even effective. You do a baseline test at the beginning of the year cognitively for concussion. In your mind, what are the pros and cons of it, and do you think it has value . I do think it has value as a tool. It is not an endall, beall. We do use baseline testing here in washington, d. C. Public schools. We have a great resource in the childrens score clinic. They anecdotalally do not necessarily feel its completely necessary for them to have the athletes baseline scores when theyre evaluating and treating. But it can also be a good tool, has an objective, objective data for me to show my coach. And so when the coach is getting antsy or a parent is getting antsy or the kid is getting antsy, i can use that to my advantage and say, well, look, youre not quite back