evaluation methods among Washington state high school football coaches and
athletic trainers

Murphy A, Kaufman MS,
Molton I, Coppel DB, Benson J, & Herring SA. (2012). PM&R, 4:419-426.

Sports medicine
personnel are more likely to identify a concussion if clinicians use a
multifaceted assessment approach that incorporates the evaluation of signs and
symptoms, cognition (memory, processing, decision-making), coordination,
balance, and vestibular ocular function. This is because ‘concussions are like
faces, they’re all different’ (Joseph Torg, MD). The standardized concussion
evaluation form 2 (SCAT2) provides most of these evaluations in a convenient
package and its use for sideline evaluation is recommended. Furthermore, the
continued use of these assessments as well as neurocognitive testing (NCT; e.g.,
ImPACT) during managed return to play protocol is also recommended. The authors
in the present study examined the awareness of these concussion evaluation methods
among athletic trainers and football coaches in urban and rural Washington
state high schools. In June 2010 participants completed a 12 question online
survey that asked about demographics, SCAT2 and NCT use, and Zachery Lystedt
Law knowledge and influence, and concussion education training. A total of 59
surveys (36 athletic trainers, 21 coaches, 2 duel role) were collected for a survey response
of 30% (which is good). Athletic trainers and urban district participants
(coaches and athletic trainers) were more likely to report using SCAT2 and NCT
versus coaches and rural participants. All knew of the Lystedt Law and athletic
trainers seemed to have much more concussion education training versus
coaches.  Most coaches received training
from the school district while most athletic trainers had training at local or
national conferences. Within the athletic trainers’ data 30 of 36 used the SCAT2
or other sideline assessment (e.g., SAC), while 6 provided no answer.  Age may have played a role in these results
but it is difficult to determine because age data were not broken out by
position (athletic trainers vs. coach).  The study
highlights that athletic trainers (particularly in rural areas) need to remain
vigilant in using the ‘state of the art’ in concussion injury management.  It is likely that the percentages of
individuals using appropriate tools would be higher today.  Although these data are only from 2010,
concussion awareness seems to have increased dramatically since that time. 

A cursory read of this
article could result in many individuals believing that coaches and athletic
trainers have equal roles in player concussion management.  Particularly in the abstract and results
sections the authors refer to coaches ‘management practices’ and their ‘use of…’
concussion assessment or management tools. The authors noted in the
introduction and methods that they were not equating coaches and athletic trainers
in their concussion management roles, only that coaches may know which
assessments are being used to manage their players, and in some circumstances,
may themselves use a tool if an athletic trainer is not present.  It is important to realize that all
situations are different and one athletic trainer could be responsible for
multiple players, teams, or schools. 
Therefore coaches, as well as officials, parents, school nurses and
administrators, etc., are part of the team and can play an important role in
injury identification and management.  Whenever
possible an athletic trainer, however, has the primary role for the injury identification
and management and should therefore be knowledgeable and at least collaborate
with personnel who utilize recommended concussion management tools. What are
some barriers that prevent athletic trainers from using (or teaming up with
personnel that use) the most up-to-date management tools?

Written by: Ryan Tierney
Reviewed by: Jeffrey

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Murphy A, Kaufman MS, Molton I, Coppel DB, Benson J, & Herring SA (2012). Concussion evaluation methods among washington state high school football coaches and athletic trainers. PM & R, 4 (6), 419-26 PMID: 22732154