Q and A With Dr. Richard C. Hunt
Dr. Richard C. Hunt is the director of the Division of Injury Response at the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention. Hunt, who has 20 years of experience in emergency medicinne, has held the post since 2004.
Since joining the CDC, Hunt led efforts to improve emergency care and reduce injuries and injury-related deaths through evidence-based practices in field triage and trauma care nationally and internationally. In this position, he also guides research, surveillance, and educational activities on traumatic brain injury, alcohol screening and brief intervention, as well as programmatic activities conducted at over 30 state health department injury programs. State Legislatures spoke with him about concussions in young athletes.
State Legislatures: Why is addressing concussions among young athletes important to CDC?
Dr. Richard C. Hunt: Among the more than 38 million boys and girls who participate in organized youth sports in the United States today, concussions are one of the most commonly reported injuries. Though they are sometimes described as “dings” or having one’s “bell rung,” even a seemingly mild bump or blow to the head can be serious. While most athletes who sustain a concussion will recover, some will continue to have problems that can affect the way they think, learn, feel and act. CDC wants to help keep athletes safe and healthy by improving prevention, recognition and response to concussion, so that all young athletes can live to their full potential.
SL: What is a concussion?
Hunt: A concussion is a type of traumatic brain injury, or TBI, caused by a bump, blow or jolt to the head that can change the way your brain normally works. Concussions can also occur from a fall or a blow to the body that causes the head and brain to move quickly back and forth. Health care professionals may describe a concussion as a “mild” brain injury because concussions are usually not life-threatening. Even so, their effects can be serious.
SL: What are steps people can take to feel better after a concussion?
Hunt: Rest is very important after a concussion because it helps the brain to heal. Ignoring concussion symptoms and trying to “tough it out” often makes symptoms worse. Only when symptoms have reduced significantly, in consultation with a health care professional, should an individual slowly and gradually return to their daily activities, such as work or school. If symptoms come back or new symptoms appear as a person becomes more active, this is a sign that he or she is pushing themselves too hard. The person should stop these activities and take more time to rest and recover. As the days go by, the person can expect to gradually feel better. Here are additional tips to help people feel better after a concussion:
- Get plenty of sleep at night, and rest during the day.
- Avoid activities that are physically demanding (e.g., sports, heavy housecleaning, working-out) or require a lot of concentration (e.g., sustained computer use, video games).
- Ask a health care professional doctor when it is safe to return to sports, drive a car, ride a bike, or operate heavy equipment.
- Do not drink alcohol. Alcohol and other drugs may slow recovery and put a person at risk of further injury.
SL: Why is it important for athletes to be removed from play if they have a suspected concussion?
Hunt: If an athlete has a concussion, the brain needs time to heal. An athlete should not return to play the day of the injury and until a health care professional, experienced in evaluating for concussion, says the athlete is symptom-free and it’s OK to return to play. A repeat concussion that occurs before the brain recovers from the first—usually within a short time period (hours, days, weeks)—can slow recovery or increase the chances for long-term problems. In rare cases, repeat concussions can result in edema (brain swelling), permanent brain damage and even death.
SL: What is the role of the state legislature?
Hunt: State legislators can play a significant role in ensuring that all stakeholders take the correct actions in responding to and helping someone who has experienced a TBI. For example, coaches of youth sports should be encouraged or directed to receive training in how to respond to athletes who may have experienced a concussion. Research shows that CDC’s materials help change coaches views on concussion and the seriousness of this injury and can help improve their ability to recognize and respond appropriately. Creating policies that enable healthcare providers to appropriately diagnose and treat TBIs are important steps as well as making sure that policies include an evaluation component to assure that they are having the intended impact.
SL: What is the CDC doing to help coaches and parents know how to recognize and respond to concussions?
Hunt: CDC knows that coaches and parents are on the front line for helping to ensure the safety of young athletes. So it is important that they are equipped with concussion information and action steps they can keep with them on the field, court, ice, or track. So beginning in 2005, CDC launched, the “Heads Up: Concussion in High School Sports” initiative. This initiative, which continues to grow in popularity, was developed for high school coaches, athletic directors, athletic trainers, parents, and athletes with the goal of raising awareness and improving prevention, recognition, and response to concussion. Building on this initiative, in July 2007, CDC released the “Heads Up: Concussion in Youth Sports” initiative for youth sports coaches, parents, and athletes. To date, CDC has disseminated about 1.5 million of these materials. All of these materials include concise steps on identifying a concussion, a concussion action plan for when a concussion is suspected, and prevention tips. Next steps include development of sports-specific materials, such as those CDC already completed with USA Football, US Lacrosse, and USA Hockey, and releasing a free online training for coaches in summer 2010.
SL: Young athletes are also students, so what should school professionals know about helping students return to school after a concussion?
Hunt: School professionals play an important role in helping students return to school after a concussion, as students may need to limit activities during recovery. Activities such as studying, working on the computer or playing video games may cause concussion symptoms to reappear or get worse. Students who return to school after a concussion may need to:
- Take rest breaks as needed
- Spend fewer hours at school
- Be given more time to take tests or complete assignments
- Receive help with school work
- Reduce time spent on the computer, reading or writing
Supporting a student with a concussion requires a collaborative approach among school professionals, health care providers, parents, and students. To help support school professionals, CDC developed the new “Heads Up to Schools: Know Your Concussion ABCs” initiative. This initiative provides information for school nurses, parents, and counselors, teachers and other school professionals (K-12) on recognizing a concussion and helping with return to school following a concussion. CDC worked with over 30 school, health and medical organizations to develop and test these materials.
SL: Is there concern that student athletes will lie about symptoms to get back in the game?
Hunt: There’s no doubt about it: Sports are a great way for 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 sometimes don’t recognize their own limitations—especially when they’ve had a concussion. Research shows that some athletes may hide or not report their concussion symptoms. They may tell their coach or parent that they are “just fine” or they can “tough it out.” That is why getting information into the hands of coaches, parents, and athletes is so important. Coaches and parents know their athlete well and can help recognize and make the call to pull an athlete off of the field, ice court, or track if he or she might have a concussion. Athletes also need to be vocal about their symptoms and those of their teammate. CDC wants athletes to know that playing with a concussion can lead to long-term problems. It can even be fatal.
SL: If you could clear up one myth about this issue, what would it be?
Hunt: It is important for people to know that there is no one single indicator for concussion. Rather, recognizing a concussion requires watching for different signs and symptoms—some of which may not show up right after the injury. While 15 to 20 years ago, loss of consciousness was considered a key indicator of concussion, research now shows that only 10 percent of athletes with a concussion actually lose consciousness. That means that if we only focus on that one indicator, we are missing a very large number of athletes who may be left in play with a concussion and vulnerable to further injury and long-term problems.