Addressing Concussion Among Kids and Teens: on and Off the Playing Field

ACTIVITY REPORT

Addressing Concussion Among Kids and Teens: On and Off the Playing Field

Activity Report | 2011

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention National Center for Injury Prevention and Control

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION THANK YOU!

The importance of the current (and future) Heads Up participating organizations in ensuring the success of these initiatives cannot be overstated. Through your consistent and tireless efforts, we are helping to keep young athletes healthy and active, and for this we THANK YOU!

Below is a quick summary of what we have accomplished together:

60+ million media impressions through print media and TV public service announcements (PSAs) More than 4 million print resources distributed 300,000+ coaches completing online trainings 200% increase in CDC’s concussion and TBI webpage views Over 40 Heads Up products developed 4,000+ Facebook fans, and growing More than 85 participating organizations Close to 20 million social-media impressions 2,000+ participants in Heads Up webinars 20+ radio PSAs and podcasts created Heads Up Participating Organizations

Amateur Athletic Union National Athletic Trainers Association American Academy of Family Physicians National Center for Sports Safety American Academy of Pediatrics National Collegiate Athletic Association American Academy of Physical Medicine and Rehabilitation National Council for Accreditation of Coaching Education American Association for Health Education National Council of Youth Sports American Association of Cheerleading Coaches National Education Association and Administrators National Education Association Health Information Network American Association of Neurological Surgeons National Federation of State High School Associations American College of Emergency Physicians National Football League American College of Physicians NFL Players Association American College of Sports Medicine National Interscholastic Athletic Administrators Association American Counseling Association National Program for Playground Safety American Medical Society for Sports Medicine National Recreation and Park Association American School Counselor Association National Operating Committee on Standards for American School Health Association Athletic Equipment American Society of Pediatric Neurological Surgery National Safety Council American Speech-Language-Hearing Association National School Boards Association American Youth Soccer Organization National Youth Sports Coaches Association Association of State and Territorial Health Officials North American Brain Injury Society Baltimore Ravens Oakwood Hospital Brain Injury Association of America Pittsburgh Penguins Foundation Brain Injury Association of Michigan Pop Warner Little Scholars Brain Injury Association of Washington President’s Council on Physical Fitness and Sports Brain Trauma Foundation Safe Kids Worldwide CDC Foundation Safe States Alliance Chicago Wolves Seattle Seahawks Children’s National Medical Center Special Olympics International Children’s Safety Network Sports Legacy Institute Detroit Lions State and Territorial Injury Prevent Directors Association Emergency Nurses Association The Children’s Hospital of Philadelphia EMSC National Resource Center USA Baseball Health Resources and Services Administration USA Basketball Huskers - University of Nebraska - Lincoln USA Cheer Institute for Preventative Sports Medicine USA Cycling Institute for the Study of Youth Sports USA Diving Major League Soccer USA Football Massachusetts Department of Public Health USA Field Hockey Michigan High School Athletic Association USA Hockey National Alliance for Youth Sports USA Roller Sports National Assembly on School-Based Health Care USA Rugby National Association for Sport and Physical Education USA Skateboarding National Association of County and City Health Officials USA Softball National Association of Elementary School Principals USA Volleyball National Association of School Nurses US Lacrosse National Association of School Psychologists US Ski and Snowboard Association National Association of School Resource Officers US Soccer National Association of Secondary School Principals US Youth Soccer National Association of Social Workers Wayne State University National Association of State School Nurse Consultants

Addressing Concussions Among Kids and Teens: On and Off the Playing Field

Activity Report | 2011

U.S. Department of Health and Human Services | Centers for Disease Control and Prevention National Center for Injury Prevention and Control

Contents

Heads Up Initiatives—An Overview...... 8 Supporting Materials and Resources...... 13 Heads Up: Concussion in High School Sports...... 14 Heads Up: Concussion in Youth Sports...... 14 Heads Up to Schools: Know Your Concussion ABCs...... 16 Heads Up to Clinicians...... 17 Partnership and Promotion...... 18 Impact...... 22 Materials Evaluation...... 24 Heads Up: Concussion in High School Sports...... 24 Heads Up: Concussion in Youth Sports...... 25 Heads Up to Schools: Know Your Concussion ABCs...... 26 How to Become Involved...... 28 Get Started ...... 29 Build Momentum...... 30 Reach the Media...... 30 Resources...... 33 Ongoing Efforts and Future Plans...... 34 Heads Up Initiatives— An Overview

Heads Up is a series of educational programs, developed by the Centers for Disease Control and Prevention (CDC), that all have a common goal: to help protect people of all ages, especially Addressing Concussions Among Kids and Teens: On and Off the Playing Field On and Off the Playing Among Kids and Teens: Concussions Heads Up: Addressing children and teens, from concussions and their potentially devastating effects.

ACTIVITY | ACTIVITY REPORT For nearly 10 years, the Heads Up initiative has provided materials to key audiences who play a critical role in helping keep children and teens safe from concussions. Initially, Heads Up materials addressed health care professionals and their important role in diagnosing and managing concussions. More recent Heads Up initiatives focus on sports programs and schools as key places to share messages that will help improve traumatic brain injury (TBI) and concussion prevention, recognition, and response among children and teens.

Parents, coaches, school nurses, teachers, and other school professionals are frequently the first people in a position to recognize and respond to concussion symptoms, and thereby potentially help prevent long-term problems. They are also well-positioned to help educate others about concussions and how to respond.

8 For nearly 10 years, the Heads Up initiative has provided materials to key audiences who play a critical role in helping keep children and teens safe from concussions. What Is a Concussion?

A concussion is a type of traumatic brain injury (TBI) caused by a bump, blow, or jolt to the head—or by a hit to the body—that causes the head and brain to move rapidly back and forth. This sudden movement can make the brain bounce around or twist in the skull, stretching and damaging the brain cells and creating chemical changes in the brain. Some researchers believe that children may be more vulnerable to the chemical and metabolic changes that occur in the brain as a result of a concussion.

Why Is It a Special Health Concern for Children and Teens?

Falls account for half of all TBIs among children aged 0-to-14 years and, each year, kids and teens aged 5-18 years account for an estimated 65% of emergency department visits for sports and recreation-related TBIs, including concussions.1,2

Concussions can have a serious effect on a young, developing brain, causing short- and long-term problems affecting a child’s thinking, language, learning, behavior, and/or emotions. While most kids and teens with a concussion recover quickly and fully, some will have symptoms that last for days, or even weeks. A more serious concussion can last for months or longer.

1 Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010. 2 Gilchrist J, Thomas KE, Wald M, Langlois J. Nonfatal traumatic brain injuries from sports and recreation activities— United States, 2001-2005. Morbidity and Mortality Weekly Report (MMWR) July 27, 2007; 56(29):733-37.

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Developed in 2005, Heads Up: Concussion in High School Sports Heads Up: Addressing Concussions Among Kids and Teens: On and Off the Playing Field was the first education and awareness-building effort focusing on children and youth participating in sports and recreational activities. Designed for high school athletic coaches, this program aims to 1) educate coaches about concussions and the role that coaches can play both to help prevent them and to limit their effects when they occur, and 2) prepare those coaches to educate athletes and their parents about these same issues.

The success of Heads Up: Concussion in High School Sports led to the development of a second sports-related project, Heads Up: Concussion in Youth Sports, with similar objectives but a different target audience.

Many coaches in youth sports programs are volunteers—either parents or other interested people—who may have minimal or no training in coaching and safety and are generally juggling many other commitments.31

Yet, these youth sports coaches are also on the front line in the effort to identify and respond to concussions, and they can play an important role in sharing this information with the parents of young athletes and with the athletes themselves. The Heads Up: Concussion in Youth Sports initiative has experienced great success and has helped create a national conversation about this injury in training rooms and homes, and on sidelines and benches nationwide. The reach of this initiative is largely attributed to the participating organizations that have helped put this information in the hands of coaches, parents, and athletes.

3 Wiersma LD, Sherman CP. Volunteer youth sports coaches’ perspectives of coaching education/certification and parental codes of conduct. Res Q Exerc and Sport 2005; 76(3):324-38.

11 Recognizing that concussions don’t just affect students on the playing field, in 2010 CDC createdHeads Up to Schools: Know Your Concussion ABCs for school nurses, teachers, principals, and other school professionals who work with students ages 5-18 (grades K-12) during the school day. Heads Up to Schools: Know Your Concussion ABCs focuses on prevention and recognition of concussion in school settings.

Because teachers and other school professionals see their students regularly, they are often among the first to recognize that a student may be experiencing concussion symptoms. Thus, it is important to educate school professionals about the signs and symptoms of concussion—and the need for cognitive rest among students who are recovering from a concussion—so that

Addressing Concussions Among Kids and Teens: On and Off the Playing Field On and Off the Playing Among Kids and Teens: Concussions Heads Up: Addressing they can help students return to school and, in partnership with the student’s parent(s) and health care professional, assist with proper management of a concussion. ACTIVITY | ACTIVITY REPORT

The reach of this initiative is largely attributed to the participating organizations that have helped put this information in the hands of coaches, parents, and athletes.

ACTIVITY REPORT | Heads Up: Addressing Concussions Among Kids and Teens: On and Off the Playing Field 131313

and Resources the meet designed to a set of materials CDC has developed audiences— of each of these Heads Up educational objectives sports youth high school coaches, professionals, health care teachers, school nurses, administrators, and program coaches those for as tools well and other school professionals—as such as audiences secondary use in reaching to audiences and parents. athletes/students ensure to feedback provided each audience from Representatives and that the design and actionable, relevant was that the content methods research appealing and usable. Other were and format with experts, focus interviews reviews, used include literature in-depth interviews. and individual groups, Supporting Materials Materials Supporting Heads Up: Concussion in High School Sports

The initial set of materials was developed in 2005 with the help of an expert work group representing health professionals, Resources high school administrators, coaches, and athletic trainers. The materials were later updated, and a revised set of materials was • Online training for high released in 2010 with input from an additional expert work group. school coaches developed in partnership with the National Federation of State High School Associations

• Guide for coaches All concussions are serious. If you think you have a • Fact sheets for parents UP A FACT SHEET FOR ATHLETES HEADSIN HIGH SCHOOL SPORTS CONCUSSION:Don’t hide it. (in English and Spanish) CONCUSSION What is a concussion? What should I do if I think I have a concussion? Report it. A concussion is a brain injury that: • Tell your coaches and your parents. Never ignore a • Is caused by a bump, blow, or jolt to the head bump or blow to the head even if you feel fine. Also, or body. tell your coach right away if you think you have a Take time to recover. • Fact sheets for athletes • Can change the way your brain normally works. concussion or if one of your teammates might have a • Can occur during practices or games in any sport concussion. Addressing Concussions Among Kids and Teens: On and Off the Playing Field On and Off the Playing Among Kids and Teens: Concussions Heads Up: Addressing or recreational activity. • Get a medical check-up. A doctor or other health • Can happen even if you haven’t been knocked out. care professional can tell if you have a concussion • Can be serious even if you’ve just been “dinged” and when it is OK to return to play. (in English and Spanish) or “had your bell rung.” • Give yourself time to get better. If you have a concussion, your brain needs time to heal. While your All concussions are serious. A concussion can affect brain is still healing, you are much more likely to have your ability to do schoolwork and other activities (such another concussion. Repeat concussions can increase as playing video games, working on a computer, the time it takes for you to recover and may cause studying, driving, or exercising). Most people with a more damage to your brain. It is important to rest and • DVD of Brandon’s Story concussion get better, but it is important to give your not return to play until you get the OK from your U.S. DEPARTMENT OF HEALTHAND HUMAN SERVICES brain time to heal. health care professional that you are symptom-free. UP CENTERS FOR DISEASE CONTROL AND PREVENTION HEADSIN HIGH SCHOOL What are the symptoms of a concussion? SPORTSHow can I prevent a concussion? You can’t see a concussion,CONCUSSION but you might notice Every sport is different, but there are steps you can • Clipboard sticker one or more of the symptoms listed below or that you take to protect yourself. “don’t feel right” soon after, a few days after, orSIGNS even AND SYMPTOMS• Use the proper sports equipment, including personal ACTION PLAN weeks after the injury. protective equipment. In order for equipment to • Headache or “pressure”Athletes in head who experience one or moreprotectof the you, signs it must and be:symptoms If you suspect that an athlete has a concussion, you should take • Nausea or vomiting listed below after a bump, blow, or- joltThe toright the equipment head or forbody the may game, position, or activitythe following four steps: • Coach’s wallet card with tips • Balance problems or dizzinesshave a concussion. - Worn correctly and the correct size and fit 1. Remove the athlete from play. • Double or blurry vision - Used every time you play or practice 2. Ensure that the athlete is evaluated by a health care • Bothered by light or noise Signs Observed by • Follow Symptomsyour coach’s Reported rules for safety and the rules professional experienced in evaluating for concussion. • Feeling sluggish, hazy, foggy, or Coachinggroggy Staff of the sport.by Athlete Do not try to judge the seriousness of the injury yourself. It’s better to miss one game • Difficulty paying attentionAppears dazed or stunned • Practice goodHeadache sportsmanship or at all times. 3. Inform the athlete’s parents or guardians about the possible

ACTIVITY | ACTIVITY REPORT • Poster with concussion signs • Memory problems “pressure” in head concussion and give them the fact sheet on concussion. than the whole season. • Confusion Is confused about assignment or position If youNausea think or youvomiting have a concussion: 4. Keep the athlete out of play the day of the injury and until For more information and to order additional materials free-of-charge, visit: . Don’t hide it. Report it. Take time to recover. a health care professional, experienced in evaluating for www.cdc.gov/Concussion Forgets an instruction Balance problems concussion, says the athlete is symptom-free and it’s OK to or dizziness return to play. and symptoms Is unsure of game, score, or opponent Double or It’s better to miss one game than theblurry whole vision season. IMPORTANT PHONE NUMBERS U.S. DEPARTMENT OF HEALTHAND HUMAN SERVICES For more information andMoves to order clumsily additional materials free-of-charge, visit: www.cdc.gov/Concussion. CENTERS FOR DISEASE CONTROL AND PREVENTION Sensitivity to light Emergency Medical Services Answers questions slowly Name: Sensitivity to noise • Athlete videos U.S. DEPARTMENT OF HEALTHAND HUMAN SERVICES Phone: Loses consciousness June 2010 (evenCENTERS briefly) FOR DISEASE CONTROLFeeling AND PREVENTIONsluggish, hazy, June 2010 foggy, or groggy Health Care Professional Shows mood, behavior, Name: or personality changes Concentration or Phone: memory problems • Radio PSAs Can’t recall events School Staff Available During Practices prior to hit or fall Confusion Name: Can’t recall events Just not “feeling right” Phone: after hit or fall or is “feeling down” • Podcasts School Staff Available During Games It’s better to miss one game than the whole season. Name: For more information and to order additional materials free-of-charge, visit: Phone: www.cdc.gov/Concussion. • e-Health cards June 2010 • Web buttons and banners

Visit www.cdc.gov/Concussion to download or order all materials for free.

Heads Up: Concussion in Youth Sports

To develop the Heads Up: Concussion in Youth Sports initiative and materials, CDC conducted additional research to understand the unique needs of youth coaches and the types of organized youth sports activities around the country.

14 ACTIVITY REPORT | Heads Up: Addressing Concussions Among Kids and Teens: On and Off the Playing Field 15

www.cdc.gov/Concussion Online training for youth for Online training parents sports and coaches coaches for sheet Fact parents sheet for Fact (in English and Spanish) athletes sheet for Fact (in English and Spanish) clipboard and Clipboard with concussion stickers for signs and symptoms coaches Magnet with concussion for signs and symptoms and parents coaches with concussion Poster signs and symptoms athletes, coaches, Quiz for their test to and parents knowledge concussion (in English and Spanish) Radio PSAs Podcasts e-Health cards and banners buttons Web Resources • • • • • • • • • • • • Visit all or order download to free. for materials COACHES COACHES illion 2 RVICES E S MAN U H As many as 3.8 m A Fact A Sheet Fact for . ity v and ALTH ALTH AND - E H change in the athlete’s behavior, change in the athlete’s behavior, www.cdc.gov/ConcussionInYouthSports that results of movement in rapid the head. the signs the and signs symptoms of concussion listed on the page.) next thinking, or physical functioning. (See or physical functioning. thinking, loss of consciousness. PARTMENT PARTMENT OF . RECOGNIZING A RECOGNIZING POSSIBLE among athletes: your CONCUSSION you a help recognize concussion, To should watch two the for things following to A blow the forceful head 1. or body recreational actirecreational sports- and concussions recreation-related occur in the States United each year. 2. Any 2. E CENTERS FOR DISEASE CONTROL AND PREVENTION . r, U.S. D without in any . sport howeve serious , brain injury www.cdc.gov/ConcussionInYouthSports can help prevent further injury or even death. e the skull. Even a “ding,” “ding,” e Even the a skull. d Para descargar la descargar en Para hoja para informativa los español, entrenadores por favor visite: Concussions can Concussions occur first occur first A concussion A is concussion a All concussions All are concussions Concussions can Concussions occur Recognition and management proper Recognition of whenconcussions they Concussions can Concussions occur 1 THE FACTS THE FACTS • • • • • organized or unorganized sportor unorganized organized or To download the coaches To fact sheet in Spanish, please visit It’s better to miss one game than the whole season. any rious. Concussions can Concussions also result from a rious. apidly insi apidly in athletic environments where collisions are where athletic collisions environments “getting your bell rung,” or what bell your “getting rung,” seems to be bump a or to mild blow the head can be se with fall each or from colliding players other or such with as obstacles, a goalpost. potential The is concussions for greatest in WHAT A IS WHAT CONCUSSION? common. A concussion A is concussion caused by a to blow the head or body that causes the to brain move r A concussion A is concussion an injury that changes how the cells in the work. normally brain

, visit: visit: , 2007 2007 July ERVICES S Confusion free-of-charge Sensitivity to light Sensitivity to noise Nausea or vomiting Does not “feel “feel right” Does not UMAN Double or blurry vision H Balance problems or dizziness Headache or “pressure” in head “pressure” Headache or Concentration or memory problems Feeling sluggish, hazy, foggy, or groggy foggy, hazy, sluggish, Feeling ou should take steps: the following SYMPTOMS SYMPTOMS REPORTED ATHLETE BY y EALTH EALTH AND H with permission from an health appropriate with permission ACTION PLAN only SIGNS AND SIGNS SYMPTOMS CENTERS FOR DISEASE CONTROL AND PREVENTION www.cdc.gov/ConcussionInYouthSports www.cdc.gov/ConcussionInYouthSports EPARTMENT EPARTMENT OF Moves clumsily Moves U.S. D Forgets sports Forgets plays It’s better to miss one game than the whole season. Answers Answers questions slowly Appears dazed or stunned For more information and to more materials order For information additional Loses consciousness briefly) (even Can’t recall after events hit or fall Can’t recall prior events to hit or fall Is unsure of game, score, or Is opponent unsure score, of game, Shows behavior or behavior Shows personality changes These signs and symptoms may indicate that a concussion has occurred. Is confused about assignment or position care professional. care professional. to judge of the the seriousness injury yourself. them the give fact sheet on concussion. SIGNS OBSERVED BY COACHING STAFF

If you If suspect you that a player has a concussion,

1. Remove athlete from play. athlete Remove from play. 1. 2. Ensure athlete is Do by evaluated not an health tryappropriate care professional. athlete’s 3. Inform parents or aboutguardians the known or possible and concussion 4. Allow athlete to return to play July 2007 2007 July CDC conducted six focus groups with youth sports and coaches youth with groups six focus CDC conducted the materials—and of a pilot version test administrators—to to of participating organizations dozens with relationships formed the for materials of the revised further the creation gain input into only contributed not organizations Participating audiences. target the to accessing critical but also proved the materials, refining to the materials. and marketing audiences diverse and suggestions, educational materials providing In addition to in High School Sports Heads Up: Concussion for the resources the Plan before Heads Up Action set up a four-step help coaches in the Heads Up: coaches sports sheet for season starts. A fact coaches— for similar guidance Sports offers in Youth Concussion in a wide athletes with youth work most of them volunteers—who of sports. variety This research revealed that youth sports coaches were eager for for eager were sports coaches youth that revealed research This and protect and supportmaterials them do their jobs well help to their athletes. Assess Be alert for Contact a the signs and health care situation symptoms professional Assess Be alert for Contact a Assess Be alert for Contact a Assess Be alert for Contact Assess Be alert for Contact a the signs and health care the signs and health care the signs and the school the signs and health care situation symptoms professional situation symptoms professional situation symptoms nurse situation symptoms professional Heads Up to Schools: Know Your Concussion ABCs

This effort aims to provide a wider range of school professionals with Heads Up materials. CDC conducted background research

Assess Be alert for Contact a with school professionals to learn the following: the signs and health care situation symptoms professional How health issues are addressed in school settings Resources Current knowledge of concussions Interest in educational materials • Fact sheet for school nurses Effective ways ot reach this audience to help guide the • Fact sheet for teachers, development of the approach and materials counselors, and other school professionals • Fact sheet for parents (in School nurses, counselors, teachers, and administrators at grade Addressing Concussions Among Kids and Teens: On and Off the Playing Field On and Off the Playing Among Kids and Teens: Concussions Heads Up: Addressing English and Spanish) levels K-12 reviewed the materials. Their feedback guided CDC • Concussion signs and revisions. The revised materials were re-submitted for review symptoms checklist before they were finalized. • Magnet with concussion signs and symptoms To support the development, promotion, and dissemination of the ACTIVITY | ACTIVITY REPORT • Poster with concussion signs materials, CDC engaged a range of organizations that address and symptoms national education and school-health issues. • Poster for school nurses developed in partnership Some suggestions for ways with the National to use these resources in the

Association of School Nurses

Assess Be alert for Contact a school environment are included the signs and health care • Laminated card with situation symptoms professional on CDC’s Web site. These Signs and Symptoms concussion signs and of a Concussion A concussion is caused by a bump, blow, or jolt to the head. Concussions can also occur from a fall suggestions are drawn from or blow to the body that causes the head to move rapidly back and forth. Even what seems to be a mild bump to the head can be serious. Be alert for any of the following signs and symptoms. symptoms

SIGNS OBSERVED BY SCHOOL PROFESSIONALS formative research with • Appears dazed or stunned • Can’t recall events after hit, bump, or fall • Is confused about events • Loses consciousness (even briefly) • Answers questions slowly • Shows behavior or personality changes • Repeats questions • Forgets class schedule or assignments the array of target • Can’t recall events prior to hit, bump, or fall Visit www.cdc.gov/Concussion SYMPTOMS REPORTED BY THE STUDENT Thinking/Remembering Physical Emotional • Difficulty thinking clearly • Headache or “pressure” • Irritable • Difficulty concentrating in head • Sad audiences who or remembering • Nausea or vomiting • More emotional than usual to download or order all • FeelingA Fact more Sheet slowed for down Parents• Balance problems or • Nervous • Feeling sluggish, hazy, dizziness foggy, or groggy • Fatigue or feeling tired Sleep*

Assess Be alert for Contact a • Blurry or double vision • Drowsy the signs and health care What are the signs and symptoms • Sensitivity to light or noise • Sleeps less than usual elaborated on ways situation symptoms professional materials for free. of a concussion? • Numbness or tingling • Sleeps more than usual • Does not “feel right” • Has trouble falling asleep What is a concussion? You can’t see a concussion. Signs and symptoms of concussion can show up right after an injury or may not A concussion is a type of brain injury that changes appear or be noticed until hours or days after the injury. *Only ask about sleep symptoms if the injury occurred on a prior day. the way the brain normally works. A concussion is It is important to watch for changes in how your child or they would want to use caused by a bump, blow, or jolt to the head. Concussions teen is acting or feeling, if symptoms are getting worse, can also occur from a blow to the body that causes the or if s/he just “doesn’t feel right.” Most concussions occur head and brain to move rapidly back and forth. Even what without loss of consciousness. seems to be a mild bump to the head can be serious. What can school professionals do? If your child or teen reports one or more of the symptoms of Concussions can have a more serious eﬀect on a young, concussion listed below, or if you notice the symptoms Know your Concussion ABCs: developing brain and need to be addressed correctly. yourself, seek medical attention right away. Children and

various materials. teens are among those at greatest risk for concussion. A—Assess the situation

SIGNS AND SYMPTOMS OF A CONCUSSION B—Be alert for signs and symptoms 0102 yaM SIGNS OBSERVED BY SYMPTOMS REPORTED BY YOUR CHILD OR TEEN C—Contact a health care professional PARENTS OR GUARDIANS Thinking/Remembering: Emotional: • Appears dazed or stunned • Difficulty thinking clearly • Irritable • Is confused about events • Difficulty concentrating or • Sad • Answers questions slowly remembering • More emotional than usual • Repeats questions • Feeling more slowed down • Nervous • Can’t recall events prior to U.S. Department of HealtH anD HUman ServiceS • Feeling sluggish, hazy, foggy, or groggy centerS for DiSeaSe control anD prevention the hit, bump, or fall FREE-OFSleep-C*:HARGE Can’t recall events after the • Physical: • Drowsy hit, bump, or fall • Headache orwww.cdc.gov/Concussion “pressure” in head • Sleeps less than usual Loses consciousness • • Nausea or vomiting • Sleeps more than usual (even briefly) • Balance problems or dizziness • Has trouble falling asleep Shows behavior or personality • • Fatigue or feelingFor tiredmore information and to order additional changes • Blurry or double vision *Only ask about sleep symptoms: if Forgets class schedule or • • Sensitivity tomaterials light or noise the injury occurred ,on visit a prior day. assignments • Numbness or tingling . • Does not “feel right”

To download this fact sheet in Spanish, please visit: www.cdc.gov/Concussion. Para obtener una copia electrónica de esta hoja de información en español, por favor visite: www.cdc.gov/Concussion.

U.S. Department of Health and Human Services Centers for Disease Control and Prevention May 2010

16 ACTIVITY REPORT | Heads Up: Addressing Concussions Among Kids and Teens: On and Off the Playing Field 17

www.cdc.gov/Concussion Online training for health for Online training on professionals care in sports among concussion kids and teens guideline on practice Clinical diagnosing mild TBI among adults in the emergency setting care Booklet Physicians for Facts Concussion Acute Form (ACE) Evaluation Plan Care ACE in Sports Concussion Card Palm Heads Up: Preventing Sheet Fact Concussion Expect Heads Up: What to Fact a Concussion After Card Sheet and Wallet Podcasts and about concussion Facts help booklet get to where Resources professional: the health care For • • • • • • professional the health care For patients: to provide to • • • • Visit all or order download to free. for materials These resources provide clinical information for health for clinical information provide resources These settings. care and emergency in primary professionals care education are and referral, management, diagnosis, Appropriate achieve a concussion with and teens helping children critical to significant aftereffects. or avoid and reduce optimal recovery Practice Injury in Your Heads Up: Brain the in 2003, launched First and information, research include recent to updated was initiative assessment provide materials The in June 2007. and re-released that can assist as information as well tools, and management setting with care in the primary working professionals health care early diagnosis, through health outcomes a patient’s improving referral. and appropriate management, CDC initiative, Clinicians the Heads Up to In addition, through Physicians of Emergency College with the American partnered as well adult mild TBI clinical diagnosis guidelines, develop to patient discharge as uniform emergency use by instructions for care in the acute providers care Heads Up to Clinicians Heads Up to Clinicians setting. Next steps include working with a multidisciplinary group of experts to develop and disseminate guidance to health care professionals on pediatric mild TBI.

Most recently, with the support from the National Football League and CDC Foundation, CDC created an online training to provide health care professionals with an overview of what they need to know about concussion among young athletes. Available at no cost, this online course called, Heads Up to Clinicians: Addressing Concussion in Sports among Kids and Teens, was completed in collaboration with an expert work group and 13 leading medical organizations and includes a continuing education opportunity. Addressing Concussions Among Kids and Teens: On and Off the Playing Field On and Off the Playing Among Kids and Teens: Concussions Heads Up: Addressing Next steps include working with a multidisciplinary group of experts to develop and disseminate guidance to health care

ACTIVITY | ACTIVITY REPORT professionals on pediatric mild TBI.

Partnership and Promotion

External organizations were critical to the development of the Heads Up initiatives. Their insight in the initial planning phases— and feedback as materials were developed—helped ensure that educational objectives, content, and formats were appropriate to the audiences the initiatives were designed to reach. They also played a crucial role in promoting and disseminating materials to intended audiences.

18 ACTIVITY REPORT | Heads Up: Addressing Concussions Among Kids and Teens: On and Off the Playing Field 19 efforts. A list of current participating organizations participating organizations current Heads Up efforts. A list of campaigns through Heads Up campaigns through Launching state/city-wide community health departments, teams, and/or professional organizations policies and guidelines for develop to Using the content schools, leagues, and states Conducting online trainings and videos trainings online Conducting training or developing clinics Establishing coaching professionals school and health care for programs and press materials in press Including messaging conferences as including as well at conferences, Highlighting materials and presentations bags, agendas, in conference materials (PSAs) announcements public service and TV Airing radio social media out through Reaching events and community Hosting webinars schools, leagues, members, to Mailing print materials and communities and guidelines handbooks into messaging Incorporating parents, coaches, to outreach for materials Co-branding professionals and school and health care pages Hosting Web

The sheer number of these partners—from national professional professional national partners—from number of these sheer The and education national athletic to medical organizations of support and some sense of the degree associations—offers bring, to to and continue brought, have insight these partners CDC’s is continually list of organizations This report. is included in this ongoing in CDC’s involved become organizations as new growing Heads Up efforts. partners include the following: Heads Up Some activities by Sending mass emails Including content in magazines and newsletters Posting information on Web sites or at schools Including Heads Up in presentations at professional meetings and events

To support and supplement the efforts of its many partners, CDC has developed a number of promotional items and

National Football League (NFL). CDC has worked with the NFL Addressing Concussions Among Kids and Teens: On and Off the Playing Field On and Off the Playing Among Kids and Teens: Concussions Heads Up: Addressing on several different efforts related to the concussion-in-sports initiatives, including the development of a national television PSA that aired on CBS, FOX, NBC, ESPN, and the NFL Network, and also ran on the Times Square jumbotron in New York City. The PSA describes the importance of recognizing a concussion and taking time to recover, and warns against ACTIVITY | ACTIVITY REPORT returning to play too soon. It also directs viewers to CDC’s Heads Up Web site and concussion resources for more information. The NFL also provided funding to the CDC Foundation to develop an online training on concussion in sports for health care professionals, which was released in fall 2011.

National Collegiate Athletic Association (NCAA). CDC and the NCAA teamed up to create a PSA and other concussion education resources, including a video for student athletes, posters for every NCAA sport—men’s and women’s, fact sheets for student athletes and coaches, and concussion management plans for medical staff. The tag line for materials read: “When in Doubt. Check It Out.” NCAA distributed resources to every NCAA member campus and also led adoption of updated concussion management guidelines for college athletes.

20 ACTIVITY REPORT | Heads Up: Addressing Concussions Among Kids and Teens: On and Off the Playing Field 21 ) es, including www.facebook.com/ ounts (@CDCHeadsUp ) and Twitter acc ) and Twitter ers to write about concussion, placed banner spots in placed about concussion, write to ers Conducting a digital media campaign that engaged a digital media campaign that engaged Conducting blogg mobile applications, and earned online publisher coverage mobile applications, and earned online publisher coverage Distributing a national press release Distributing a national press and announcements releases press template Creating partners use by for via calls, emails, media contacts to the story “Pitching” and faxes tours media Running radio articles matte (in English and Spanish) and Developing services wire news newspapers, distributing them to that most sports- and which shows a study, Publishing occur include concussions) TBIs (which recreation-related and Mortality Morbidity in CDC’s and teens, among youth (MMWR) Report Weekly the initiativ promote Using social media to Facebook page ( page Heads Up Facebook CDC’s cdcheadsup resources—such as a videos, water bottles, t-shirts, bracelets, bracelets, t-shirts, bottles, a videos, water as resources—such the carry boards—that and dry-erase tattoos, temporary with materials CDC has also co-branded Heads Up messages. Hockey, USA Football, as USA (such national sports organizations resources. sports-specific create Baseball) to USA to has implemented activities that CDC Other promotional releases press issuing from range Heads Up messaging spread and tactics strategies videos. Media-outreach YouTube to included: have Impact

The collective effort between CDC andHeads Up partners has resulted in an expansive reach of materials and messages:

60+ million media impressions through print media and TV PSAs More than 4 million print resources distributed 300,000+ coaches completing online trainings 200% increase in CDC’s concussion and TBI webpage views

Addressing Concussions Among Kids and Teens: On and Off the Playing Field On and Off the Playing Among Kids and Teens: Concussions Heads Up: Addressing Over 40 Heads Up products developed 4,000+ Facebook fans, and growing More than 85 participating organizations Close to 20 million social-media impressions ACTIVITY | ACTIVITY REPORT 2,000+ participants in Heads Up webinars 20+ radio PSAs and podcasts created HEADSIN UP CONCUSSION FOOTBALL

THE FACTS

• All concussions are serious. • Most concussions occur without loss Online training for coaches has been a highly successful, of consciousness. • Recognition and proper response to concussions when they first occur can help prevent further injury or even death. important element of the sports-related Heads Up initiatives.

There’s no doubt about it: sports are a great way for kids and teens to stay healthy while learning important team-building skills. But there are risks to pushing the limits of speed, strength, and endurance. And athletes who push the limits At the close of 2011 more than 300,000 coaches had completed sometimes don’t recognize their own limitations—especially when they’ve had a concussion. How Can I Recognize a Possible Concussion? That’s where you come in. It’s up to you, as a coach, to help recognize concussion and make the call to pull an athlete off of On the football field, an online-training program for high school, youth sports, or the field if you think an athlete might have one. Playing with a concussions can result from a Sometimes people concussion can lead to long-term pro blems. It can even be fatal. fall or from players colliding wrongly believe that it shows strength and with each other, the ground, courage to play while or an obstacle, such as a injured. Discourage others What Is a Concussion? goalpost. Even a “ding,” from pressuring injured athletes to play. Some “getting your bell rung,” or A bump, blow, or jolt to the head can cause a athletes may also try to football coaches. CDC developed the trainings in partnership with concussion, a type of traumatic brain injury. what seems to be a mild hide their symptoms. Concussions can also occur from a blow to the bump or blow to the head Don’t let your athlete can be serious. convince you that he is body that causes the head and brain to move “just fine” or that he can rapidly back and forth—literally causing the “tough it out.” Emphasize brain to bounce around or twist within the As a coach you are on the to athletes and parents that playing with a the National Federation of State High School Associations as well front line in identifying an skull. This sudden movement of the brain concussion is dangerous. causes stretching, damaging the cells and creating chemical athlete with a suspected changes in the brain. Once these changes occur, the brain is concussion. You know your more vulnerable to further injury and sensitive to any increased athletes well and can recognize when something is off—even stress until it fully recovers. when the player doesn’t know it or doesn’t want to admit it. as a training video for coaches with USA Football. Unlike a broken ankle, or other injuries you can feel with your Remember, you can’t see a concussion, like you can see a hands, or see on an x-ray, a concussion is a disruption of how the broken ankle, and there is no one single indicator for brain works. It is not a “bruise to the brain.” concussion. Recognizing a concussion requires watching for different types of signs or symptoms.

22 CDC has created an assortment of sports-specific resources (from videos and fact sheets, to content for handbooks and guidelines), in partnership with the national governing bodies for sports ranging from field hockey to volleyball. 24 ACTIVITY REPORT | Heads Up: Addressing Concussions Among Kids and Teens: On and Off the Playing Field Information Sheet Parent/Athlete Concussion concussion listed below after abump, blow, orjoltto If an athlete reports If anathletereports days orweeksafter theinjury. after theinjuryormaynotappearbenoticeduntil Signs andsymptomsofconcussion canshow upright SYMPTOMS OFCONCUSSION? WHATSIGNS AND ARE THE to theheadcanbeserious. bell rung,” tobeamild seems orwhat bumporblow rapidly backandforth. Evena “ding,” “getting your theheadandbrain thatcauses head orbody tomove concussion bybump, iscaused blow, orjolttothe that changes thewaybrain normally works. A A concussion isatypeoftraumatic brain injury Loses consciousnessLoses Answers questions slowly Moves clumsily Is unsureofgame, score, oropponent Forgets aninstruction assignment about Is confused orposition dazedAppears orstunned Can’t recallevents Can’t Shows mood, behavior, orpersonality changes SIGNS OBSERVEDBYCOACHING STAFF Can’t recallevents Can’t one or more more or one after prior (even briefly) (even

hit orfall tohit orfall symptoms of

March 2011 afterabump, blow, or jolt to the head or body may have aconcussion. Athleteswho experience any of the signs and symptoms listed below

Answers questionsslowly Answers Shows mood,behavior,Shows assignment or positionassignmentor or Forgets an instructionForgetsan Loses consciousnessLoses Can’t Can’t recall eventsrecall Can’t Signs Observed by SignsObserved Is confused about confused Is prior to hit or fall or hit to prior personality changespersonality routine or cheer routineor after hit or fall or hit after Moves clumsilyMoves Coaching Staff Coaching Appears dazed Appears (even briefly) (even Is unsureofIs or stunned or Formore information and safety resources, visit: r symptom-free andit’sOKtoreturn toplay. experienced in evaluating for concussion, sayss/heis day oftheinjuryanduntil ahealthcareprofessional, the headorbody, s/heshould bekeptofplaythe out ecall events ecall • have,• Athleteswho atanypoint in their Most concussions• Most occur Know? You Did Just not “feeling right” or “feeling down” Confusion Concentration problems ormemory Feeling sluggish, hazy, foggy, orgroggy Sensitivity tonoise Sensitivity tolight Double orblurry vision Balance problems ordizziness orvomitingNausea Headache or “pressure” in head SYMPTOMS REPORTEDBY ATHLETES Young children andteensaremorelikely to than adults. get aconcussion andtake longer torecover risk for another concussion. lives, hadaconcussion haveanincreased of consciousness. SIGNS AND SYMPTOMSAND SIGNS www.cdc.gov/Concussion Feeling sluggish, hazy,sluggish, Feelingfoggy, Does not “feel right”or “feel not Does Double or blurry vision blurry or Double Symptoms Reported Symptoms Sensitivity to noise to Sensitivity Nausea or vomiting or Nausea Sensitivity to lightto Sensitivity “pressure” in head “pressure”in without Balance problemsBalance is “feeling down”“feeling is memoryproblems Concentrationor . Headacheor or dizziness or by Athlete by Confusion

or groggy or IN CHEERLEADING loss you should take the following four steps: followingfourthetake should you If you suspect that an athlete has a concussion,a has athlete an that suspect you If .Informthe athlete’s parents or guardians 3. about the possible concussion 2. Ensure that the athlete is evaluated by a health care professionalcarehealth a by evaluated is athlete the Ensurethat 2. 1. Remove the athlete from activity.from athlete the Remove 1. 4. Keep the athlete out of activitiesof out athlete the Keep 4. seriousness of the injury yourself. injury theseriousnessof experienced in evaluating for concussion. Do not try to judgetheto try not concussion.evaluatingexperiencedDo for in says they are symptom-free and it’s OK to return to cheerleading.to return to OK it’s andsymptom-free are they says professional,carehealth concussion,evaluating experiencedfor in and give them the CDC fa CDC thethem give and Phone: Name: Competitions & Games AvailableDuring Staff School/Gym/League Phone: Name: PracticesAvailableDuring Staff School/Gym/League Phone: Name: ProfessionalCare Health Phone: Name: Services EmergencyMedical IT’SBETTER TO MISS ONE GAME THAN THE WHOLE SEASON. IMPORTANT PHONE NUMBERS IMPORTANTPHONE ACTION PLAN ct sheet for parents on concussion.parentson forsheet ct th e day of the injury and until a untiland injury theof day e Sports”. JournalofSchoolHealth MarchSports”. 2010;80(3): 112–118. Prevention’s concussion initiative for highschoolcoaches: “Heads Up:Concussion inHighSchool 4 Sarmiento K,Mitchko J, KleinC,Wong S.Evaluation oftheCenters for DiseaseControl and and skillsrelated to concussion prevention andmanagement: changes inhighschoolcoaches’ knowledge, attitudes,behavior, of SchoolHealth.This evaluation studydemonstrated positive Heads Up:Concussion initiative inHighSchoolSports intheJournal In March 2010, CDCpublishedanevaluation studyofthe Heads Up:ConcussioninHighSchoolSports Evaluation Materials including Pop Warner Little Scholars, Safe KidsWorldwide, co-branded resources were created withmultipleorganizations, for ranging sports from fieldhockey to volleyball. Additional and guidelines), inpartnershipwiththenationalgoverning bodies resources (from videosandfact sheets,to content for handbooks In addition,CDChascreated ofsports-specific anassortment seriously after usingthetool kit seriously after Half ofcoaches polledreported viewing concussions more for athletictrainers. create andevaluate apiloteducationprogram Kids Worldwide alsousedthematerials to the Baltimore Ravens, among others. Safe ofPublicMassachusetts Department Health,and Council ofYouth Legacy Sports Sports, Institute, National Alliance for Youth National Sports, 4 ACTIVITY REPORT | Heads Up: Addressing Concussions Among Kids and Teens: On and Off the Playing Field 25 5 67% of coaches reported being able to more easily identify more being able to reported of coaches 67% a concussion have who may athletes seriously more concussions viewing 68% reported about others educated had that they reported 72% including concussions, and managing preventing and other coaches parents, athletes, 68% reported using the tool kit to educate others others educate kit to the tool using 68% reported and athletes, other coaches, including about concussions, their parents dealt with they in how making changes 38% reported on training emphasis more including placing concussions, the risk equipment that minimize and safety techniques of concussion An evaluation study conducted by Michigan State University and University State Michigan by study conducted An evaluation Sports on the Heads Up youth Youth for the National Alliance materials, that after using the initiative’s found sports initiative the following: stated coaches Heads Up: Concussion in Youth Sports Heads Up: Concussion in Youth 5 Covassin T, Elbin RJ, Sarmiento K. Educating coaches about concussion in sports: about concussion coaches K. Educating Sarmiento Elbin RJ, T, 5 Covassin In press. Sports” initiative. in Youth Up: Concussion “Heads of the CDC’s evaluation Heads Up to Schools: Know Your Concussion ABCs

Pre- and post-surveys with 140 nurses were conducted by Children’s National Medical Center for the Heads Up to Schools initiative, before and after a half-day educational workshop for school professionals in Maryland. The following findings were collected:

100% of nurses reported greater knowledge of the definition of concussion 100% reported greater knowledge of signs and symptoms of a concussion 100% reported greater knowledge of the danger signs

Addressing Concussions Among Kids and Teens: On and Off the Playing Field On and Off the Playing Among Kids and Teens: Concussions Heads Up: Addressing of a concussion 99.3% reported greater knowledge of academic strategies A significant increase in confidence rating of nurses’ ability to recognize and respond to concussions ACTIVITY | ACTIVITY REPORT

26 ACTIVITY REPORT | Heads Up: Addressing Concussions Among Kids and Teens: On and Off the Playing Field 27 “I went went “I

to school the next day after the game, but I felt really sick.” The feelings of nausea, dizziness, of nausea, dizziness, feelings The sick.” really but I felt after the game, day school the next to the felt and she had a concussion grader As a seventh familiar. all too vision were and blurred same way. and nauseous and thought that she dizzy felt Tracy later, days came up two game When a key the athletic tell to I didn’t want the athletic trainer. tell me to told coach “The had a concussion. As played.” quiet, but I shouldn’t have So I kept game. sit me out of the he would ’cause trainer but after the game, win the to hard played Tracy team, her high school basketball a starter for room. out in the locker she passed game but I didn’t know I knew, which me I had a concussion, the hospital and told me to took “They headaches, nauseous and have feel to continued Tracy change.” about to was life that my to put sheets on the had “We reading. and concentrating and difficulty problems, balance make TV because the lights and noise would watch block out the light, and I couldn’t to windows so dizzy blurry and I felt vision was my ‘cause help me walk sick. My mom also had to me feel most of my school and missing to go not being able to part was all of the time. But the hardest of high school.” junior and senior years every the doctor at home. She visited stay to Tracy forced the concussion from Symptoms years Three with balance. because of her problems again walk to learn how month and had to the from but she still struggles with symptoms better, feel is beginning to Tracy after the injury, shouldn’t be living.” a teenager the life old, but I am living years am 19 “I concussion. a have think you If you is a serious injury. concussion that “A know to other teens wants Tracy than the one game miss to better It’s recover. time to it. Take don’t hide it; report concussion, whole season.”

Keeping Quiet Can Keep You Out of the Game You Keep Quiet Can Keeping didn’t see the Tracy the rebound, for on reaching focused Her eyes her head. with her and hit she collided before other player Tracy’s True Story… Tracy’s How to Become Involved

The examples of activities highlighted throughout this report are some of the many ways in which individuals, as well as organizations, can become involved in building awareness and knowledge of Heads Up messages. It takes the voice and reach of many—organizations, parents, clinicians, coaches, teachers, caregivers, and survivors—to continue the success of Heads Up.

Health care providers can encourage colleagues to visit the Addressing Concussions Among Kids and Teens: On and Off the Playing Field On and Off the Playing Among Kids and Teens: Concussions Heads Up: Addressing CDC Web site for clinically relevant information and participate in continuing-education activities. Parents can become informed about how concussion-related issues are being addressed in their children’s schools and organized sports

ACTIVITY | ACTIVITY REPORT activities and—if adequate plans and procedures are lacking— promote enhanced efforts.

Members of Facebook can post “likes” for some of the concussion-related CDC Web sites, or send Tweets directing Twitter followers to those Web sites. There are ways that everyone can get involved. In the Resources section (page 33) are additional ideas on how to get started. Please visit the CDC Heads Up Facebook page at www.facebook.com/cdcheadsup to share your stories and activities.

There are multiple ways to use CDC’s Heads Up series communitywide to protect young athletes from concussion. In fact, many individuals and groups are using Heads Up resources to meet their state’s requirements, and/or fulfill policy objectives, as well as to support individual coaches and parents, leagues, schools, organizations, departments, and others.

28 ACTIVITY REPORT | Heads Up: Addressing Concussions Among Kids and Teens: On and Off the Playing Field 29 www.cdc.gov/Concussion. Download or order Heads Up materials — in Spanish too — for athletes at . www.cdc.gov/Concussion e. Send , and post the oncussion resources at community events, events, at community resources oncussion dcheadsup educational messages on educational messages though safety concussion other social-media channels. Facebook widget widget Heads Up Facebook from directly connect to sit Web your trainings for coaches and health care professionals, and professionals, and health care coaches for trainings areas. sports and recreation summer camp, league, in youth Include Heads Up resources including CDC’s packets, and school sports registration sheet. information parent/athlete concussion in facilities at sports and recreation Hang Heads Up posters and at schools. community your site Web on your and banners Heads Up buttons Post and coaches, for online trainings Heads Up CDC’s linking to as to as well professionals, health care for online training resources. other free with CDC Connect at Heads Up on Facebook www.facebook.com/ c materials to leagues and schools in to Send out Heads Up materials area. your c Distribute Get Started Following are some ideas on how to get started, ranging from from started, ranging get to on how some ideas are Following coaches, parents, to engage efforts larger-scale small activities to the to can also refer You policy-makers. and even and athletes, at “Heads Up Game Plan” available Learn about your state, league, or sports governing body’s laws or policies on concussion and use Heads Up materials to help support implementation of these policies. Include concussion education messages—and links to resources—in your team, school, and community newsletter/eNewsletter and other publications.

Build Momentum

Work with CDC to create a Heads Up campaign in your community. Partner with schools and colleges, professional teams, and youth leagues to host educational trainings on concussion

Addressing Concussions Among Kids and Teens: On and Off the Playing Field On and Off the Playing Among Kids and Teens: Concussions Heads Up: Addressing pittsburgh for school and health care professionals, parents, coaches, and athletes. Create a Heads Up game night and distribute free concussion resources to attendees.

ACTIVITY | ACTIVITY REPORT Host a Heads Up logo-design contest or a short video contest to give kids and teens the opportunity to educate other young athletes about this issue. Winners could be displayed/aired at the Heads Up game night.

Partner with Reach the Media local online, print, radio, and TV Partner with local online, print, radio, and TV journalists and producers (especially sports reporters and anchors) to journalists and air a Heads Up PSA on concussion. You can also work with producers to air them to create customized educational PSAs. Establish and educate media contacts, and work with a Heads Up PSA them to include concussion prevention and safety tips in on concussion. community media outlets and at media events.

30 Partner with schools and colleges, professional teams, and youth leagues to host educational trainings on concussion for school and health care professionals, parents, coaches, and athletes. Cole’s True Story…

Coach Saves Wrestler’s Life by Knowing Concussion Signs and Symptoms

“I went to the emergency room and was told not to return to wrestling for at least a month. I ignored the doctor and returned to wrestling after one week,” said Cole. “During practice, one of the coaches noticed a problem, and pulled me out. My neurologist believes this action by my coach saved my life.”

When Cole’s mother picked him up from practice, she noticed something was wrong and immediately : Addressing Concussions Among Kids and Teens On and Off the Playing Field On and Off the Playing Among Kids and Teens Concussions Heads Up : Addressing Addressing Concussions Among Kids and Teens: On and Off the Playing Field On and Off the Playing Among Kids and Teens: Concussions Heads Up: Addressing took him to the emergency department. The doctor diagnosed Cole with a concussion and instructed him to rest and to not return to wrestling for about a month.

Despite this advice, Cole snuck out to practice after a week. He did not tell his family that he was going there, or the coach that he wasn’t supposed to be there. Fortunately, his coach knew all ACTIVITY REPORT | REPORT ACTIVITY ACTIVITY | ACTIVITY REPORT about concussion.

“My high school encourages coaches to take CDC’s online concussion training and has concussion- awareness posters in many locker rooms,” said Cole. “I am so grateful for these posters and trainings!”

CDC’s free online training for coaches helped his coach recognize that Cole was acting clumsy and appeared stunned. Cole was answering questions slowly and seemed to be having trouble with his memory. Cole’s coach had learned that these were signs of concussion.

Although most athletes with a concussion recover quickly and fully, some—like Cole—may have longer-term challenges that are both cognitive (thinking and learning activities) and physical, especially if they return to play too soon.

“This was certainly one of the worse decisions I have made. It’s been several months and I’m still recovering. But I will probably never be able to wrestle again just because I wanted to get back to practice,” said Cole.

It isn’t easy to keep a talented and ambitious athlete like Cole on the sidelines, especially when he wants to get back into play. And sometimes people believe that it shows strength and courage to play when you’re injured. Not only is that belief wrong, it can put a young athlete at risk for serious injury.

3232 ACTIVITY REPORT | Heads Up: Addressing Concussions Among Kids and Teens: On and Off the Playing Field 33 initiatives and messages. and messages. Heads Up initiatives omote s pr

CDC/NCAA resources CDC/NCAA slides PowerPoint and statistics Data athletes real from Stories journals, and in newspapers, articles placement Matte for other print media materials promotional and other banners Web Print materials Print programs online-training Free Videos and other social media links Facebook TV and Radio PSAs videos YouTube Podcasts Sports-specific information CDC/NFL resources

Some of those items include: Some of those items Resources Resources have that some of the resources has described report This initiatives— and teen the Heads Up children for been developed Those them in partnership with other organizations. of many at site Web concussion on the CDC’s available are materials . www.cdc.gov/Concussion that can help an and products also includes materials site This of stakeholder array Heads Up educational resources (available at no cost) align with components in many concussion in sports laws and policies, including:

• Online course for youth coaches and parents. In • Online course for health care professionals (with less than 30 minutes coaches and parents can learn support from the NFL and CDC Foundation) on about identifying a suspected concussion and how concussion in sports diagnosis and return-to-school to respond. After completing the training and quiz, and -play management. This one-hour course provides coaches and parents can print out a certificate, an overview of what health care professionals need making it easy to show their league or school they are to know about concussion in sports and includes ready for the season. (CDC also partnered with the a no-cost continuing education opportunity through National Federation of State High School Associations the American College of Sports Medicine. on an online training for high school coaches.) All are available at www.cdc.gov/Concussion. • Parent/Athlete information sheet with signature lines that can be ordered or downloaded and distributed during registration or before the first practice.

Addressing Concussions Among Kids and Teens: On and Off the Playing Field On and Off the Playing Among Kids and Teens: Concussions Heads Up: Addressing Ongoing Efforts and Future Plans ACTIVITY | ACTIVITY REPORT

CDC is continuing to disseminate materials in response to requests, and to develop new channels and partnerships to promote their availability. Listed below are some upcoming efforts:

Launch of the Heads Up to Parents initiative, including the development of videos and other electronic resources for parents, through support from the National Operating Committee on Standards for Athletic Equipment through the CDC Foundation. Gather the latest research and convene a group of experts to develop clinical guidance on identification and management of pediatric mild TBI for health care professionals. Development of a video for young athletes, as well as TV public service announcements with professional athletes.

3434 www.cdc.gov/Concussion