MCPS

Supt. Josh Starrs Proposed Operating Budget for FY 2014 (July 2013 to June 2014) Recommendations by Tom Hearn For Athletic Trainers at High Schools January 16, 2013 (Updated January 27, 2013) Good evening, Superintendent Starr and members of the Board of Education for Montgomery County [Maryland] Public Schools (MCPS). My name is Tom Hearn and I am a parent of a student at an MCPS high school. I want to speak to you about three aspects of the Operating Budget for FY 2014 that you will recommend to the Montgomery County Council: 1. Athletic Trainers at Each MCPS High School 2. Whether to Include the Proposal for Concussion Baseline Testing; 3. Budget Neutral Ways that MCPS Can Improve Sports Safety I have previously advocated for funding for athletic trainers in public comment to Supt. Starr and the Board of Education on April 30 and May 21, 2012.1 I make these recommendations mindful that: Athletic trainer funding must compete with other important funding choices in the MCPS budget, including chronic understaffing of school counselors and school psychologists; The County-funded portion of Supt. Starrs $2.2 billion MPCS FY 2014 Operating Budget proposal is $1.458 billion, which is $10 billion more than the County is required to fund under: (1) Marylands requirement that county funding per student be no less than the previous year funding (the maintenance-of-effort requirement); and (2) the shift of teacher pension costs to the local school board; and the County Council must also fund equally critical county government functions, such as police and fire protection, provide care for the most vulnerable members of Montgomery County, and give services for all county residents such as libraries. Nevertheless, the lack of certified athletic trainers at MCPS high schools represents a serious public safety issue. High school athletics programs represent a significant source of concussions and other injuries to high school students who play sports. Some 1 Testimony to MCPS Supt. Starr and Board of Education, April 30, 2012
http://www.scribd.com/doc/122435826/Sports-Concussions-Parent-Testimony-to-MCPS-Supt-Starr-andBd-of-Ed-April-30-2012 ; Testimony to MCPS Supt. Starr and Board of Education, May 21, 2012 http://www.scribd.com/doc/97421191/Sports-Concussions-Parent-Testimony-to-Montgomery-Cty-MdBoard-of-Ed-May-21-2012-Comparison-of-Sports-Concussion-Surveillance-in-Mont-Cty-and-Fair

concussion professionals say that if you cant afford to have athletic trainers, maybe you cant afford to have a sports program. So please find a way to work with the County Council to include funding for athletic trainers in the 2014 MCPS budget. Background My son sustained a serious concussion playing JV football at Whitman High School in 2011. While managing his recovery, I became interested in ways that MCPS could better align itself with best practices for dealing with sports concussions. I testified to the MCPS Board of Education and to the Maryland State Board of Education between May and July of last year regarding concussion safety issues. As I engaged MCPS last year on ways to improve concussion safety, I became aware of other sports safety areas in which MCPS could better align itself with best practices, such as screening for pre-existing heart attack risk, female health issues, and concussion history in the annual sports physical. In the coming months, I hope to advocate for MCPS to adopt best practices for managing the risk of heat stroke among football players and other athletes, especially during summer workouts. As you know, three and a half years ago, Edwin Dek Miller of Northwest High School died of heat stroke during a no-pad conditioning workout with the schools football team. MCPS still does not currently appear to be following best practices for managing heat stroke. You owe it to Dek Millers family to get this right so that his death would not have been in vain and so that none of our other sons or daughters are lost to what experts say is a completely preventable condition. Certified Athletic Trainers Please include in the recommended FY 2014 Operating Budget $500,000 for funding to pay for certified athletic trainers at each MCPS High School. I see three benefits to having an athletic trainer at each of MCPSs 25 high school. First, the trainer degree is a four-year college program and trainers must pass a national certification program. Coaches are only required to take an injury course and watch a 30minute online concussion awareness program. So athletic trainers bring a deeper knowledge about concussions and other sports injuries. Having trainers also allow coaches to, well, coach. Second, trainers maintain detailed records of injuries. Such records allow administrators to see trends, e.g. football representing half of all concussions, boys versus girls concussion rates in the same sports. Also, managing a student athlete's return to play involves several milestones such as the doctor's clearance and successful completion of the graduated return to play steps. At Maryland high schools staffed with athletic trainers, the trainers perform this function. This function does not appear to get done at

MCPS high schools. Third, a trainer is not authorized to clear a concussed student for return to play, a trainer may override a doctor's clearance if the trainer thinks that the student is not ready. I have heard numerous instances of doctors clearing students for RTP where a trainer later found the student to still be exhibiting symptoms.2 Other Maryland School Systems Have Athletic Trainers The map of Maryland counties at this link reflects my survey of athletic trainer staffing at Marylands 24 local school systems. http://www.scribd.com/doc/120598273/Map-Athletic-Trainers-at-Maryland-Public-HighSchools As you can see, numerous other school systems, including Howard, Anne Arundel, and Frederick Counties have athletic trainers at each high school. Not on the map is Fairfax County, Virginia, just across the Potomac River, where each of its 25 high schools is staffed with two full-time certified athletic trainers. I am attaching an October 15, 2012 memorandum from Supt. Starr to the Board of Education responding to Board member Mike Dursos request at the September 24, 3012 Board meeting for information about the cost of athletic trainers.3 Supt. Starr estimates $500,000 for the cost of staffing athletic trainers at each of MCPSs 25 high schools. 2 While having a certified athletic trainer for a high school athletics program greatly improves student
safety, it does not guarantee it. In 2010, Austin Trenum, a high school student in Prince William County, Virginia committed suicide two days after sustaining a concussion playing football. Trenums high school sports program was staffed with athletic trainers. http://www.washingtonian.com/articles/people/did-football-kill-austin-trenum/ Similarly, in 2011, Derek Sheely died from head trauma sustained in football practice at Frostburg State University in Maryland. Frostburg States athletic program was staffed with certified athletic trainers. (More information about Derek and his families efforts to raise awareness about sports concussion can be found at http://www.thedereksheelyfoundation.org/ ) Finally, the benefits of having an athletic trainer on staff can be undone by a weak sports safety culture among coaches. In 2007, Scotty Eveland sustained a serious brain injury playing high school football in Mission Hills, California. It was alleged that the high school football coach disregarding concerns raises by an athletic trainer about Evelands continuing to play after reporting concussion symptoms. (For more information see the account here http://concussioninc.net/?p=5535 ). Nevertheless, having athletic trainers on staff significantly increases the safety of students who play sports.
3 http://www.scribd.com/doc/122380238/10-15-12-Memo-MCPS-Supt-Starr-to-BOE-Re-Cost-of-

Providing-Athletic-Trainers-at-25-High-Schools . I had also asked for such information in my October 4, 2012 email (at following link) to Supt. Starr and the Board of Education after the Athletic Director at Walt Whitman High School had indicated to the schools Booster Club that the cost or staffing trainers at all high schools would be $2 million to $3 million per year. http://www.scribd.com/doc/122435296/10-04-12-Email-to-MCPS-Supt-Starr-and-Bd-of-Ed-RequestingInfo-on-Cost-of-Athletic-Trainers-at-MCPS-s-25-High-Schools

Note that this figure is for each of the 25 high schools to have a part-time trainer hired through a local medical practice or physical therapy group. If MCPS were to staff each of its 25 high schools with a full-time trainer, Supt. Starr estimated that the cost would be close to $1.5 million. Disclose to Parents the Risks of Not Having Trainers If such funding is not included in the FY 2014 Operating Budget, please have staff evaluate whether it is safe for MCPS to operate interscholastic football and other high contact sports such as lacrosse and soccer in FY 2014. Robert Cantu MD, a leading concussion expert, and others have said, if you cant afford to have athletic trainers, you probably cant afford to have a sports program. If MCPS does go forward with football and other high contact sports programs, it should specifically disclose to parents the heightened risk of allowing their children to participate in such sports without athletic trainers on staff. Such disclosure needs to be given at off-season meetings held by coaches to give parents information about the sport. In the coming weeks, MCPS high school football coaches will hold informational meetings for parents of middle school eight graders. Coaches of football and other high contact sports should be required to disclose the lack of athletic trainers at these informational meetings so that parents can make informed decisions about whether to allow their child to participate in the sport. Concussion Baseline Testing Supt. Starr included in his FY 2014 Operating Budget proposal $75,000 for concussion baseline testing at each of MCPSs 25 high schools. Because this would be a new expenditure and no budget savings from last year is identified, it is assumed that this $75,000 proposal would be among the $10 million in funding that has been proposed in excess of the maintenance-of-effort requirement. If the County Council somehow funds MCPS $75,000 in the budget, MCPS high school students would be better served if the funds were used to hire a sports safety professional to advise it on incorporating best practices in operating a safe sports program in managing and preventing concussions, heat stroke, and other injuries. Alternatively, $75,000 could be used to fund athletic trainers at 3 or 4 high schools as a base of staffing that could be added in subsequent years. Other Maryland school systems have taken this approach. As to the proposal, there are certain questions about the $75,000 number. The Superintendents September 5, 2012 press release on baseline testing indicated that currently the boosters clubs of 9 MCPS high schools pay $750 per school to obtain ImPACT baseline testing on students who participate in athletics. That rate multiplied by

25 high schools results in only $18,750. Of this amount, $6,750 is currently paid by the booster clubs at the 9 schools where baseline testing is conducted. So it would appear that only $12,000 in additional funding is needed to obtain baseline testing at the other 16 schools. Are there additional costs included in the $75,000 included in the recommended budget? Is this the cost of having the testing conducted by trained neuropsychologists? From my own experience managing my sons concussion, I have several observations about baseline testing. First, the limitations of baseline testing must be understood. As a physician at our school said last year at a concussion forum, Baseline testing is not a vaccine against getting a concussion. Second, many people still expect comparing a post-concussion test against a baseline to be the equivalent of an X-ray or blood test for diagnosing a concussion. Its not. Such post-concussion testing is just one tool in the toolbox, Third, my overall concern is that funding concussion baseline testing is a third- or fourthorder priority far behind: (1) having athletic trainers on staff; (2) having clear policies for removing possibly concussed students from play; (3) notifying school nurses when a concussion is suspected; (4) having policies for following gradual-return-to play steps; and (5) having sport-specific protections, like limits on full contact practice in football. All but the first of these are budget neutral, yet we dont do them in MCPS. So in the absence of these essential steps, implementing baseline concussion testing may be a form of sports safety theater, making people feel safer about letting their kids play sports without significantly increasing safety. Budget-Neutral Ways to Improve Sports Safety Below are several budget-neutral steps that MCPS could take to improve sports safety. 1. Concussion Forms Recommended by MSDE in 2011: In August 2011, the Maryland State Department of Education recommended that local school systems use two forms for schools to use when a concussion is suspected and for documenting a health professionals clearance for a previously concussed student to return to play. The MSDE forms were the product of a working group of physicians, neuropsychologists, and athletic trainers. The forms incorporated the essential gradual return-to-play concepts. They also incorporate the practice of notifying a schools nurse when a concussion is suspected. As shown on the linked map of Maryland counties, my survey in the last few months indicated that MCPS is the only one of Marylands 24 local school systems that does not use the MSDE forms. http://www.scribd.com/doc/120603284/Map-of-Maryland-Counties-Where-PublicSchool-Systems-Use-Concussion-Forms-Recommended-by-MSDE-and-MPSSAA

I first advocated for the MCPS Athletics Department to use the MSDEs recommended forms in February 2012 and again on June 14, July 30, and October 16, 2012. MCPS staff continue to use an outdated form that does not educate the reviewing physician, parents, or students about the role of gradual return to play. (A link to the MSDErecommended forms and the outdated MCPS form is at this link: http://www.scribd.com/doc/120612867/Maryland-State-Dept-of-Education-ConcussionForms-Used-by-Every-Md-local-school-system-except-Montgomery-County ) 2. Notice to School Nurse When Sports Concussion Is Suspected Baltimore County Public Schools, which does not have athletic trainers at each of its 26 high schools, has a policy requiring that suspected sports concussions be reported to the school nurse. http://www.scribd.com/doc/121608812/Balt-County-Md-Public-Schools-Policy-onNotifying-School-Nurse-When-Sports-Concussion-is-Suspected-NM-3-48 Reporting suspected concussions to the school nurse helps ensure that vulnerable students get the follow up they need and dont fall through the cracks. The attached Maryland Map reflects Maryland school systems where school nurses are notified when a concussion is suspected. http://www.scribd.com/doc/122043098/Maryland-Map-Showing-Local-School-SystemsWith-Policies-of-Requiring-School-Nurse-Be-Notified-When-Sports-ConcussionSuspected In his August 24, 2012 memorandum to the MCPS Board of Education, Supt. Starr explained to the Board of Education that MCPS did not notify a school nurse when a concussion is suspected because the concussion notice form does not have a distribution line for the nurse.4 3. Collaboration with Maryland Health Officer for Montgomery County and MCHHS Head of School Nurse Program on Sports Safety Issues Howard and Baltimore County School Systems Athletics Programs collaborated with the Maryland Health Officers for the respective counties in setting up their sports concussion program. I know that MCPS high school students who play sports would be safer if MCPS Athletics Department would consult with the Health Officer for Montgomery County in setting its sports concussion policies. 4. Reporting to MCPS Board of Education on Sports Injuries

4 Memorandum of MCPS Supt. Starr to MCPS Board of Education, August 24, 2012,
http://www.scribd.com/doc/120923112/08-24-12-Memo-From-MCPS-Md-Supt-Starr-to-BOE-ReConcussion-Issues

The Howard County Board of Education gets a report every January from the school systems athletic director of all injuries, including concussions, that occurred in the previous school year. http://www.scribd.com/doc/121864839/Howard-County-Maryland-Public-SchoolsReport-of-Injuries-in-High-School-Sports-Program-2006-2011 The MCPS Board of Education has never asked for or received such a report. The old adage in education, you measure what you treasure, would seem to apply hear. The closest thing that comes to such a report is the individual sport team end-of-season coaches meetings at which MCPS coaches orally self-report injuries that they recall occurring in their program. 5. Limits on Full Contact Practice in Football Back in May 2012, I recommended that the MCPS Board of Education adopt limits on full contact practice in football as has been done by the NFL, the Ivy League, and Pop Warner football.5 I testified to Supt. Starr and the Board of Education again on July 30, 2013.6 In response, Supt. Starr wrote two memoranda to the Board, dated June 1 and August 24, 2012, indicating that there was not a sufficient basis for such measures that I had called for.7 I would ask the Supt. Starr and the Board of Education to reconsider this issue. Conclusion Thank you for listening to what I have to say. I would be happy to answer any questions you may have.

5 http://www.scribd.com/doc/93095845/Concussion-Testimony-to-MCPS-Bd-of-Ed-MD-05082012UPDATED
6 http://www.scribd.com/doc/121474514/Parent-Testimony-to-Montgomery-County-Bd-of-Ed-July-30-

2012
7 Memorandum, MCPS Supt. Starr to MCPS Board of Education, June 1, 2012.

http://www.scribd.com/doc/120923128/06-01-2012-Memo-From-MCPS-Md-Supt-Starr-to-Bd-of-Ed-ReConcussion-Issues Memorandum, MCPS Supt. Starr to MCPS Board of Education, August 24, 2012. http://www.scribd.com/doc/120923112/08-24-12-Memo-From-MCPS-Md-Supt-Starr-to-BOE-ReConcussion-Issues