Concussions are the most dangerous when undiagnosed and untreated. Historically, it was viewed as weak if you could not take a hit and get up and play. Coaches and players alike said, “shake it off, play on, and be tough.” Those days are gone. Protocols in the National Football League and others professionals leagues, as well as all high school and college sports do not allow a player to continue playing without being checked, so players will not further damage themselves. These protocols are much more strict than even five years ago. At South High, we have to sign a concussion form every year for every sport as part of a state mandate. Last year the powder puff team participant had to have concussion forms. What is different from the past? Knowledge and education have increased, so all of the stakeholders can make informed decisions. Jeffery S Kutcher , MD, from the University of Michigan Medical School stated, “If in doubt sit it out. Being seen by a trained professional is extremely important after a concussion. If headaches or other symptoms return with the start of exercise, stop the activity and consult a doctor. You only get one brain, treat it well.” Bauer stated, “Concussions are dangerous because these mild TBI (Traumatic Brain Injuries) are not visible. The injury alters the way the brain functions. Most imaging will come back with normal results. Not knowing that a person is concussed and continues to play can turn the injury into a more serious condition with long-term effects. The worst case scenario is that someone continues to play with a concussion and develops Sudden Impact Syndrome-resulting in death.” Sandra Lee Loften, Nurse Practitioner for Aurora clarifies, “Because we cannot see inside the skull and determine the amount of swelling that can cause compression on the brain which leads to certain areas of the brain to not be perfused with blood and bleeding occurs between the skull and the brain.” Once an injury has happened, concussions need to be evaluated according to the severity. Immediate removal from competition is the first step. Immediately after the injury athletes vital signs are checked along with the level of consciousness to make sure of the overall health of the athlete. Specialists, like a sports trainer, carry out these examinations. Recent guidelines state that a hospital emergency department should evaluate any child that loses consciousness as a result of trauma during a sporting event. In less severe cases, on site evaluations are common. There are a variety of approaches for such assessment as well as return to play guidelines. Return to play should be done slowly, only after acute symptoms have completely disappeared. Athletes up to high school age with a concussion” should be managed more conservatively” regarding when they are allowed back to competition, as this group takes longer to recover than older sports people. Lofton said, “The best course of treatment is no participation- rest.” Concussions are severe and dangerous for some. Are they causing changes in behavior? Numbers of football players nationally are down.The information on concussions and there effects became known in 2010-2011, since there are 21,814 fewer high school players, according to the National Federation of State High School Associations. At younger levels, ages six to fourteen, there have been a 6.7 percent drop, from 3 million to 2.8 million between 2011 and 2012. This according to Steve Alic, director of communications for USA Football. One can make the jump that these two things are connected. Bob Collgate, director of sports medicine at NFHS, said. “We’re aware that numbers are down. Numbers at Pop Warner and USA Football, and they automatically want to say it’s concussions. Concussions are a part of the puzzle, but there are a lot more parts to it.” Fewer schools are offering tackle football, according to NFHS data–two hundred and thirty one less since 2011. Tight budgets are to blame for some of these reductions, and paying fees for some families is not always an option. Parents will have to make a choice. Looking at the careers of famous players is a draw for both athlete and parent. Yet looking at the tragic brain damage that some players accrued, led PBS to make a documentary about the NFL’s lack of concussion care. This movie called “League of Denial” gives a crisis level problem to concussions in the NFL. Troy Aikman, former Dallas Cowboys quarterback who himself believes he suffered no less than three serious concussions, says that movies like these should make parents think about what is in best interest for their children. Former Packers quarterback, Brett Farve, went on the Today Show and spoke about the hits that he took during his time in the NFL. Farve stated that he did not have a son but if he did “I would be real leery of him playing football.” Other changes that have occurred over the years in rules of competition have tried to help limit football injuries. The National Collegiate Athletic Association (NCAA) in 1976 made tackling with the head illegal, and the number of head and neck injuries dropped by about 50%. The advances in helmet design have lessened the number of head injuries. This is in contrast to Medical News today in June of 2012 that found there was no compelling evidence that one type of helmet is better than another at protecting the athlete against concussion. In professional football, the concussion is clearly treated differently than in years past. Dave Duerson, a Notre Dame college player and star for the Chicago Bears committed suicide in 2011. He willed his brain to Boston University for study because he believed that his depression and mental illness problems of recent years were caused by his years of head trauma suffered in the sport of football. This trauma induced disorder or disease is CTE. Chronic Trauma Encephalopathy is linked to his death and caused a deeper look into the way the National Football League treated concussions. His rapid deterioration in his final months led to this tragic end , but the damage to players brains began to get a very serious look. “It was tragic that Dave Duerson took his own life , but it is very meaningful that he recognized the symptoms of the disorder- it validates this condition. ” said Dr. Ann Mckee, the neuropathologist who examined Duerson’s brain. She found indisputable evidence of CTE in the tissue, with ‘no evidence of any other disorder.” Duerson had blurred vision, headaches, and a memory that was sliding in the time before his death. The NFL recognized that CTE was real in their sport and was not just prevalent in boxing. Players began to speak about damage that has been done to their brains, and questioned the permanence of the damage over years of playing . His son, Tregg Duerson said, “That it was their hope that his (Dave Duerson) death and research start questions that go beyond our own interests and question that lead to a safer game of football from professional to Pop Warner.” He added “ his death will not be in vain and that through this research his legacy will live on and others will not have to suffer in the same manner.” This was just one of the first of famous cases of suicide in the NFL linked to C.T.E.. In May of 2012 Junior Seau, University of Southern California player and star of the San Diego Chargers and New England Patriots, killed himself at his home. He was emotional and called vibrant while a player. At the end he was depressed and had memory lapses. His family did not know this man. Upon his death, his family had his brain examined, and he too had CTE. The players began to see that there were indeed long term consequences to all of the hits that most of the world did not know about. As recently as 1994 the NFL was telling its players there was no proof of long term damage caused by multiple head injuries. Dr. Kevin Gusciwiecz presented findings that suggested that three or more concussions might be a trigger number and that the risk for other brain issues like dementia and premature senility would increase with more hits. There were findings that increased concussions caused a fourfold increase in depression. Commissioner Roger Goodell took a new look at the problem and made new protocols including baseline testing which looks at the cognitive function of the players before returning to play. Concussions are one of the leading causes of collective bargaining changes for retired NFL players due to players having long-range head trauma and loss of functioning and even suicide. This all led to the huge settlement for former players in the NFL. The league had agreed to pay 765 million dollars as of August 2013 because 4,500 payers had sued for damages due to fraud stating the league new of the risks, yet hid them form the players. As of January 14 2014, this lawsuit has been thrown out because a judge has deemed it not enough to cover all of the potential claims over the settlement, which covered twenty years. Story By Sara Schrank This is the second part of a three part series.