Published October 2022 in Salish Current

In October 2006, then-13-year-old Zackery Lystedt suffered a concussion while making a tackle in a middle-school football game. 

After a brief injury timeout, the Maple Valley student continued playing. Nobody suspected he was concussed until after the game, when he collapsed after a blood clot formed in his brain.

Lystedt nearly died. He spent the next 93 days at Harborview Medical Center, and it took him nine months to re-learn how to speak. Although his cognitive function remained intact, Lystedt was left physically disabled by the incident, which eventually led the Washington State Legislature to address concussion protocols for youth sports in 2009.

A law named after Lystedt requires school districts to work with the Washington Interscholastic Activities Association (WIAA) to provide concussion guidelines and educational information for coaches, athletes and parents, and to ensure those guidelines are followed.

With the Lystedt law raising awareness—as well as prompting earlier treatment—of concussion hazard, districts are implementing a new state law this year that heightens awareness.

Locally, school districts—and student athletes—are seeing benefits of the new practices, although challenges still exist.

Preventing nightmares

Beginning with the 2022-23 school year, school districts are required to report concussions to the Department of Health. The information will deepen understanding of youth concussions and the protocols meant to prevent them from turning into health nightmares.  

Under House Bill 2731—passed unanimously in both houses in 2020 and delayed in deployment during the COVID-19 shutdown—school districts must advise DOH about diagnosed concussions sustained by students during athletic events or other school activities, whether school play, biology class or field trip. The reporting includes basic information like a student’s grade, gender, when and how they received a concussion, as well as additional details:

  • Previous concussion history
  • Whether head-protecting equipment was worn when the injury occurred
  • Surface the incident occurred on
  • Who initially examined the student
  • Whether the student was removed from the activity afterward
  • Whether given written authorization to return to the activity by season’s end
  • Amount of time before authorized to return

DOH worked with the Department of Social and Health Services’ Traumatic Brain Injury Strategic Partnership Advisory Council to develop the online reporting tool, and set up training sessions for school staff. Reports may be submitted by athletic directors and trainers, school nurses, coaches or designated others. DOH will create annual reports that will be provided to state legislative committees and the state’s Office of the Superintendent of Public Instruction (OSPI). 

Local practices

Bellingham, Ferndale and Lynden school districts each reported that high-school athletic trainers—as well as some school nurses—had received training and were actively using the DOH portal. 

In both Bellingham and Ferndale, nurses are tasked with reporting all non-sports concussions diagnosed by outside medical providers. 

For athletics in particular, local districts have stringent policies in place to assess students for concussion, and to ensure all parties are aware of the risks associated. 

In the Bellingham School District, athletic directors and coordinators are required to undergo annual reviews of any changes made to forms required by the WIAA for reporting concussion, head injury and sudden cardiac arrest. Changes are to be implemented the following school year. 

Coaching staff and athletic volunteers receive annual policy updates by June 30—now also the deadline for annual concussion reporting. Coaches are also required to undergo annual training in head injury and concussion management, either by attending a WIAA session in person, completing online training or attending another training using the WIAA’s guidelines. 

In football, middle- and high-school coaches must also complete district-approved, technique-specific safety training, through a program like USA Football’s Heads Up Football.  

Each year before beginning practice in any sport, both athletes and their parents or guardians must sign information sheets on concussion and head injuries.

At Ferndale, a district representative told Salish Current, their best practice is to document concussions as they happen, but wait to officially report until each has resolved for a more complete picture. 

Assessing the hit

In an actual event resulting in a possible concussion, a school’s athletic trainer is usually the first person to evaluate the athlete. 

Bellingham considers it a coach’s responsibility to remove any athlete suspected of concussion or head injury from a practice or game. That student is not allowed to return to play until a licensed health care provider trained in concussion evaluation and management gives written clearance.

Duane Korthuis, Lynden School District’s lead athletic trainer, said the district uses three concussion tests in conjunction with clinical judgment when diagnosing a head injury, since a single test doesn’t always provide a complete picture. 

Korthuis said he is also planning to report a summary of last year’s concussions to go along with this year’s, but compiling all the information needed may be challenging. 

For one thing, he said, “There is a lot of information required related to the patient’s prior head injuries which will be difficult to ascertain.”

Ferndale High head football coach Jamie Plenkovich said certified athletic trainers are on-site during games to evaluate students. If a concussion is even just suspected, that student can’t return until cleared to do so. 

Plenkovich said awareness of concussions—on the part of everyone involved in student athletics—has greatly evolved over his 30 years of coaching in the county.

“[We’re] definitely a lot more safety-conscious in understanding them a lot more than we did when I first started coaching,” he said. “The protocols that have been put out … have done a really good job of educating everybody in how serious a head injury can be.”

Friday Harbor High School football coach Brock Hauck said the reporting process is going well so far, with a district nurse filing the reports. Hauck, who has coached for 11 years, said the protocols, from safe tackling to keeping students with suspected concussion out of the game, have been highly positive.

Still ‘ clangin’ and bangin’ ’

At a recent Squalicum High School football game, parents watching their children compete generally shared a sense that awareness is high, but the risk will always exist.   

José Robles said he always worries about his son Blaze, a senior center for the Storm’s varsity team. 

“He’s a lineman, and they’re clangin’ and bangin’ down there,” Robles said. “It’s one of the positions that’s least recognized for head injuries, because you’re worried about the ones that are getting tackled. … The linemen go kind of unnoticed down there, and they’re helmet-to-helmet a lot of the time.”

Blaze has played football since fourth grade, and received a mild concussion in the eighth grade. He thought he was okay after the hit, but José was on the sidelines and noticed his son wasn’t quite right. Blaze didn’t play another down. 

“You have to protect the player from themselves,” Robles said. “Because they don’t think it’s as bad as it is. You’ve got to be the one to really show them why it’s unsafe.”

Brain cells, muscle cells

Malakai Smith, a Squalicum sophomore linebacker who also plays basketball, said he’s never been concussed and doesn’t spend much time worrying about it. 

“If it does happen, it depends on the size of the concussion,” he said, of his concern level. Smith said he might actually try to play through a mild concussion, but would obviously sit out for a more serious one.

The parents of senior kicker Kai Sonnon have seen the latter.

Though he’s never been concussed on the gridiron, Sonnon has had two concussions while playing soccer. The most serious, which occurred while playing for the non-district Whatcom FC Rangers, put him out for two weeks. 

“We take it really seriously,” said his mom, Jodie. “His brain cell is more important than his muscle cell. He loves his sports, but we throttled back on everything and followed all of the protocols.”

Those included visiting an ophthalmologist to check Kai’s eyesight, as well as comparing his post-concussion records to the preseason baseline test he took with the Rangers. 

Rehab and re-entry

Baseline concussion tests may not always be the most accurate gauge, though.  

Andrea Lubeck, a physical therapist at Bellingham-based CorePhysio whoe is trained in concussion management, said that because the adolescent brain is still developing, a preseason test may only give a ballpark idea of the effect a concussion, compared to an adult baseline that’s unlikely to be changing much year-to-year.

Lubeck said she has seen students concussed in every sport from gymnastics to track and field, though football, hockey and rugby are most common.

A series of exams and exercises help diagnose the concussion and rule out spinal fractures or serious neurological issues. These may take more than one intake session to complete, Lubeck said, as recently concussed patients may be easily overwhelmed due to sensitivities to light and sound, or an inability to focus or remember things. 

The assessment is crucial, Lubeck said.  

“Concussion happens at a cellular level,” she said. “You cannot actually see, on imaging, that someone is concussed or not.”

Subsequent sessions test coordination and visual processing through balancing, exertion and eyesight exercises. For athletes, these exercises can be tailored to the demands of their sport, helping prepare them for a safe return to play. 

While many people can recover from concussions on their own, rehab provides a chance to fully assess which body functions are impaired and to what degree. This in turn offers a chance to ensure someone is recovering normally by tracking the progression of those functions. For this, CorePhysio relies on a series of objective test measures for concussion recovery, as well as a post-concussion symptom scale that a patient self-reports on. 

Fudging reality

It’s always possible, of course, that an athlete could answer less than honestly in an attempt to return to play sooner than advisable. Lubeck said she’s heard stories from teenagers who were advised by more senior players to fudge scores on preseason baseline tests so that—if they actually got a concussion—they might be able to return a little sooner. 

Still, Lubeck hasn’t personally seen a patient who was playing games with their head injury. 

“For the most part, when people are coming to us, they’re coming to us because they don’t feel normal and they want to feel normal,” she said. “Having a concussion really doesn’t feel good. If there’s someone that’s telling you, ‘It will get better, and this is how,’ most people are pretty receptive to that.”

In the case of more severe or repeated concussions, Lubeck said that patients who continue doing a risky activity do so with full understanding of the risk their decisions carry.

For some, the benefits of playing sports are more compelling than the chance of temporary or permanent disability from head injury. 

“The life lessons you get out of it far outweigh the risks,” said Plenkovich. “We’re helping mitigate the risks.”