The long-term health implications from concussion among players in the National Football League (NFL) were a concern for nearly 20 years. The NFL studied, debated, and finally acknowledged the issue. The individual stories of debilitating illness and suicide among NFL players has raised our nation's awareness and galvanized action to manage concussion risk in professional as well as amateur and youth sports.
As concussion risk awareness grew, nearly every state in the U.S. passed a student athlete concussion law. Most of these laws apply to school-sponsored sports programs and do not specifically apply to private, nonpublic organizations like camps.
In spite of this, these laws set an increased standard of care for camps with regard to concussion risk management. While there may be no legal precedent that imposes these standards on camps at this time, let's not wait for that to happen. Let's take action now to manage this risk aggressively.
State Laws Vary
Each state law varies, but all have a common thread requiring:
- Education and training for parents, coaches, and athletes
- Mandatory, immediate removal from play when there are any signs, symptoms, or behaviors that might be the result of closed-head trauma
- A protocol that does not allow any person who has exhibited signs, symptoms, or behaviors associated with concussion to return to activity until they have been cleared by an appropriate heath care provider trained in concussion management
Education Is the First Step
Training protects your campers and your camp. If you don't already include a section on concussion during staff training, consider including it for next summer. If you already train staff on this issue, make sure your emergency action plan and information is up to date. Engage your camp nurse and other local medical resources with experience managing concussion injuries in your process.
You might start staff training by explaining how a concussion affects the brain, then include a discussion of concussion symptoms and how to recognize them. Make certain the camp nurse and all your camp first responders are current on the latest concussion protocols.
WebMD (2015) recommends calling 911 if the person shows any of the following danger signs:
- Is vomiting repeatedly
- Has unequal pupils
- Is confused or agitated
- Has weakness on one side of the body
- Passes out or is unconscious
- Is very drowsy or unable to wake up
- Has neck pain after a fall
- Has slurred speech
- Has a seizure
Will your staff know what to do in the mean time?
The Centers for Disease Control and Prevention's Heads Up Program is an excellent source for educating staff, campers, and parents: www.cdc.gove/HeadsUp/ (CDC, 2015). Make sure all staff training is well documented.
Recognizing Signs, Symptoms, and Behaviors
Most concussions occur without loss of consciousness. According to the CDC, children and teens who say they "don't feel right" after a bump, blow, or jolt to the head may have a concussion (considered a mild head trauma) or a more serious brain injury.
Signs may include brief unconsciousness, being unable to recall events prior too or after hitting their head, appearing dazed or stunned, or answering questions slowly.
Other signs include forgetting instructions, clumsiness, and moody behavior. Other symptoms reported include headache or pressure in the head, nausea, balance issues, dizziness, blurred or double vision, as well as light and noise sensitivity.
Head Injury Statistics at Camp
The American Camp Association's Healthy Camp Study Impact Report (2011) identified injury rates for campers and staff at both resident and day camps during a five-year period (see sidebar). Some of the results were no surprise to many camp professionals; the injury rates for campers were significantly lower than the rates for many youth sports, especially football and soccer. While these statistics were encouraging, there was more to the story.
A lot of useful information was gleaned from the data. One interesting fact germane to our subject is that in resident camps 23.8 percent of the injuries were to campers' heads, necks, and face compared to 18.5 percent for staff.
Day camp data indicated campers suffered injuries to their heads, necks, and face at a rate of 32.8 percent compared to staff at 15.4 percent. In addition, one underwriter of camp insurance reported that 53 percent of the injuries in its incident and claim database are primarily caused by slip, trip, and fall. The pattern is troubling.
Specific information about how many of the head injuries may have resulted in concussion was not reported. But the impact study acknowledged head injuries can lead to lifelong disability and stressed that prevention is critical.
Many activities at camp include risk of head trauma and concussion. Some represent a greater risk than others. Spend some time identifying the activities at your camp where campers may be at risk for head injuries.
Activities with obvious high risk include soccer, lacrosse, street hockey, go karts, baseball, softball, horseback riding, biking, water skiing, diving, skateboarding, mountain boarding, and high ropes courses. Other activities may present a more subtle risk, such as playground equipment, low ropes elements, and horseplay. Make a list. What other activities are unique to your camp where the risk of head trauma needs to be managed?
Reducing the Risk of Head Injury
Use personal protective equipment (PPE). The first piece of PPE that comes to mind is a helmet. While there are no concussion-proof helmets, they play a crucial role in reducing the risk of injury. Helmets should be designed for the activity, certified, age appropriate, properly fitted, worn consistently, and well maintained (properly cleaned and stored).
Helmets designed for the activity and certified by one of the following organizations are recommended:
- American Society for Testing and Materials (ASTM)
- Snell Memorial Foundation (Snell)
- National Operating Committee on Standards for Athletic Equipment (NOCSAE)
- Consumer Products Safety Commission (CPSC)
- American National Standards Institute (ANSI)
In addition to having certified helmets designed for each specific activity, it is essential to know how each different type of helmet should be cleaned and stored. Some helmets, such as those used by equestrians, should be replaced after an impact from a fall. Others, such as a baseball or softball batter's helmet, might not need replacement after an impact. Some athletic helmets may be reconditioned and recertified.
Never use any helmet that is cracked, broken, or missing any padding or parts. Always document the storage, repair, and maintenance of helmets in a log similar to the log maintained on ropes and ropes course equipment.
Modify the Rules to Reduce Risk
When personal protective equipment is not part of the game, as in soccer, modify the rules. Because we know there is a greater risk of concussion among young children when "heading" the soccer ball, consider prohibiting this at camp.
Another example of reducing the risk of head injury by modifying the rules involves miniature golf. One counselor found a creative solution to a pattern of head and other injuries during miniature golf. While waiting their turns campers were swinging the putters like bats and dueling with them like swords. Instead of giving each camper his or her own putter, she reduced the risk of injury by issuing only one putter that was shared by all campers. The injury rate from misuse of the equipment during this activity dropped dramatically.
Re-design and Remove Hazards
An example of re-designing to reduce the risk of head and other injuries is using a bed rail on bunk beds. Another example is the ample use of soft material on ropes course elements, under climbing walls, and around playground equipment. The Consumer Products Safety Commission (CPSC, 2015) has a playground safety checklist that includes a list of appropriate materials for potential fall zones. Visit www.cpsc.gov for more information.
Leadership and Supervision
In the final analysis it is leadership and supervision that sets the example and makes the difference. Train your staff well. Educate them about all the risks at camp, especially those associated with head trauma. Insist that they enforce the camp rules including requiring the use of personal protective equipment where required. Help them expand their vision so they can anticipate the consequences of certain behaviors. Empower them with the authority to intervene when they think camper and staff safety is compromised.
To learn more and refine or develop your camp's concussion risk management plans, visit the concussion risk management resources mentioned previously at the Centers for Disease Control and Prevention.
American Camp Association. (2011). The healthy camp study impact report. Retrieved from www.ACAcamps.org/sites/default/files/ images/education/Healthy-Camp-Study- Impact-Report.pdf
Centers for Disease Control and Prevention. (2015). Heads up to brain injury awareness. Retrieved from www.cdc.gov/headsup U.S. Consumer Products Safety Commission. (2015).
Playground safety. Retrieved from www.cpsc.gov/Safety-Education/Safety- Guides/Sports-Fitness-and-Recreation/ Playground-Safety
WebMD. (2015). Concussion (traumatic brain injury). Retrieved from www.webmd.com/ brain/concussion-traumatic-brain-injurysymptoms- causes-treatments?page=2
Edward A. Schirick, CPCU, CIC, CRM, is area senior vice president of RPS Bollinger Sports & Leisure in Monticello, New York, where he specializes in arranging insurance coverage and offering risk management advice for camps. Ed is a chartered property casualty underwriter, a certified insurance counselor, and a certified risk manager. He can be reached at 877.794.3113 or Ed_Schirick@ RPSins.com. Visit www.campinsurancepro.com.