ConcussionSmart Marin is a community coalition committed to the health of Marin’s youth. Recent reporting by the Marin Grand Jury and the Marin IJ’s editorial voiced concern about Marin’s student concussion response. The coalition ConcussionSmart Marin (‘CSM’) was formed in response to the Grand Jury’s report in 2016 and has been working to address the recommendations of the grand jury’s report since that time. CSM has developed a program for middle school and high school students based on best-practice in other states and from existing models found in California. The program began roll-out to the schools in March during Brain Injury Awareness Month. The goals of CSM are to: 1) Establish a standard level of care in the assessment and treatment of concussion/mild traumatic brain injury; 2) To help in the prevention and awareness of student concussion; and, 3) Ensure schools and student athletic organizations are in compliance with current law.
While many schools in Marin have had concussion programs in place for years, the identification and medical treatment of and school response and parent community response to student concussions have been inconsistent over time and across the county. CSM understands that the issue is complex and involves many different stakeholders including students, the medical community, the education community, the county office of health and human services, the parent community and the athletic community.
CSM Program includes:
- Education for identification of concussion and understanding of signs and symptoms
- Protocols for students returning to school and to physical activity
- Forms and documentation for systematic response and care of students
- Collection of student concussion data
Concussions themselves are not standard—every brain and incident is different—but CSM wanted all parties to agree to a robust standard level of care. All parties have to understand basics of concussions as well as California concussion laws, since “buy-in” is essential to make consistent care possible. Students’ care can involve coaches, athletic trainers, doctors, hospitals, parents, teachers, school nurses, school administrators, school counselors, physical therapists and other school staff. And they all need to communicate, sometimes on a daily basis. The CSM program provides the necessary standardized forms and outline of communication protocol to provide maximum partnership between schools, parents, coaches, and physicians in the care of an injured athlete.
The science of concussions is evolving. The CSM program is based on data gained from local physicians and hospitals, as well as clinicians outside the county who are experts in concussion. Latest findings and recommendations from the 2017 Berlin guidelines were incorporated into the program. CSM hosted a symposium of concussion experts for physicians and other interested parties at Buck Center on Aging, May, 2017. Topics covered multiple disciplines and videotaped presentations are posted on CSM site. Live presentations have been made to Marin hospitals and schools.
Cost should be no object to the welfare of our children, but the fact is that not all schools can afford to pay for athletic trainers at every game or computerized baseline testing for every student. For years schools have weighed whether mandatory baseline testing should be required for every student athlete. Test results are only as good as the person administering the test and the person evaluating the results. Baseline test manipulation is possible on the part of the student. The physician community has told CSM the current standard neurological assessment is the SCAT test. There are new testing methods available—from the helmet sensors worn by San Rafael High athletes to the eye-tracking software available at Stanford—but how feasible and reliable these methods are is still under review. Again, this is an area that is evolving.
It was determined that the data collected regarding the incidence of concussion in students should be housed by those who understand public health data at the County Office of Public Health who has the mechanism for housing public health data. Concussion data has been collected for the past year and continues this year. The natural location of this historical data lies with our partner – the County of Marin where it can be accessed by all.
An interactive website, ConcussionSmartMarin.org was created to host information and provide access to videos, links and downloadable forms. Roll-out of the program to the schools continues and is near completion. Parent education and student education is in progress and will be ongoing. CSM wants transparency, input and assistance in helping care for kids.
ConcussionSmart Marin is a coalition comprised of representatives from the following:
- Certified Athletic Trainers – MCAL schools
- Kaiser Permanente
- Marin Athletic Foundation
- Marin County Office of Education
- Marin General Hospital
- Marin School Nurses Organization
- Schurig Center for Brain Injury Recovery
- Sutter Health Novato Community Hospital
