Community ExperienceAnn l. Engelland, MDHarrison and Mamaroneck school districtsBarnard college health service

What we thought then….• Run them around

following head injury• Awaken patient

every two hours• Shine bright light in

eyes to check for ??• RTP often in same

game (dings and bell

ringers)

What we think we know now…• Rest is mainstay

• Sleep is therapy

• Recognize photophobia

• Sit out ‘til symptom-free

This is about effecting change…

Is it about creating a better helmet?

• “When eight-year-olds are hitting each other-in tackle practice—with roughly the same G-forces as college players, what’s badly needed is a paradigm shift, a universal up-draft in thinking.”

“This is your brain on football” by Paul Solotaroff

Rolling Stone Magazine, January 2013

How do we do that?

How to make policy changes

NOT JUST POLICY CHANGE ala NYState Guidelines

NOT JUST by inducement from the Attorney General

IT’s about CHANGE BY RELATIONSHIPS, sometimes one at a time

We can listen to Dr. Atul Gawande and others

My experience• 5 schools: – 4 public school districts– 1 college

• Private practice

• Policy-making in four settings• Book writing and blog • Twitter, Facebook • Google alerts

Who needs education?

How to reach the audience

Ways to Teach• Faculty meetings• Staff in-services (health, athletics, guidance, social work,

psych)• Correct errors diplomatically• Make it easy and use checklists

• SECONDARY HEALTH OFFICE• CONCUSSION CHECKLIST• • Student:________________________ Grade:_______ Today’s Date:________• • Date of Injury:_______________ Notified by:______________________• Description of injury:_______________________________________________• • Current Sport:_____________ Counselor:___________________• • Date:• _____ Concussion package mailed/given & discussed with parent. • • _____ Add information on Database & PE alert list• • _____ Signed parental consent received • • _____ Email teachers/counselors alerting of concussion or head injury • • _____ Incident report if injury occurred on school property• • _____ Baseline/Prior Impact on file? If yes then have student re-test when symptom free Part C or consult School MD

to determine when to Impact• • _____ Check medical chart for previous concussions: List Concussion Hx dates:_________________• • _____ If medical note necessary for school attendance – then advise Counselor need for Concussion Team Meeting• • ______ Completed Part C returned – check w/ counselor to see how student is doing academically before sending School

MD paperwork• • _____ Email School MD Post MTBI & medical paperwork & advise School MD of Information in Bold below & feedback

from counselor/teachers RTL• SECONDARY HEALTH OFFICE• CONCUSSION CHECKLIST•

More ways to teach• Website development• School newsletter• Medical resources in community• Psychiatric and Neuropsych resources• Resource for the injured with guide to recovery

Films to view and show• Head Games• The Smartest Team• Crash Reel• United States of Football ?

What needs emphasizing• Non-sports injuries are prevalent

What needs emphasizing• Prevention starts in pre-season

What needs emphasizing• DON’T FORGET TO ASK ABOUT HISTORY

What to emphasize• Exercise and Fitness, Team sports are important to a healthy

childhood

What needs emphasizing• Holistic and individualized approach to each injury is required

What needs emphasizing• College level: no NCAA umbrella rules!

What NOT to emphasize• New helmets, bells and whistles• Different equipment• ImPACT testing unless very experienced• Long term disability risk ?• Beware of snake oil salespeople

“Now promise me you will all be very careful.”

It’s All in Your Head:Everyone’s Guide to managing Concussions

Ann Engelland, MD