Coach Kirk Marks of the Northfield Cardinals junior football league team watches his players struggle to their feet after a hard hit with one thought.
"Every time a kid goes down, you're like, ‘Oh my God, I hope he doesn't have a concussion,'" he said.
A potential concussion would have been the last thing on Marks' mind when he first started coaching the Cardinals in the Atlantic County Junior Football League, or ACJFL, 14 years ago.
But more and more New Jersey youth sport leagues are training coaches to be aware of the signs of concussions and to bench players who might have suffered a head injury.
New Jersey Youth Soccer, which oversees recreation and travel soccer in the state, mandated this year that all its coaches take a video course on concussions. For the past two years, representatives of AtlantiCare have spoken to ACJFL coaches about concussions.
Stephen Rice, a pediatrician with Jersey Shore Sports Medicine in Neptune, Monmouth County, and a nationally known expert on youth concussions, says it's about time youth leagues became concerned about head injuries.
The number of children 19 and younger coming to U.S. hospital emergency rooms with concussions rose 63 percent in the past decade, from 153,000 in 2001 to 250,000 in 2009, according to a Centers for Disease Control and Prevention study. But most youth sports events do not have trainers or doctors on the sidelines.
"It's hard to imagine anybody could be coaching children and be unaware of the symptoms of concussions," Rice said.
But the extra training has raised questions about how much organizations should ask from volunteers and how much responsibility should volunteers be given. Some volunteers might decide the extra work and responsibility is not worth it.
"Are we going to lose volunteers? Maybe," said Rick Meana, director of coaching for New Jersey Youth Soccer. "But in the long run, things are going to be a lot safer. In today's world, you have to be trained. That's what organized sports have become. You have to be aware of everything. You're entrusted with someone else's children."
Paul Richards, president and field director for the Mainland United Soccer Association, ran the concussion training for that group, which covers Northfield, Linwood and Somers Point.
Coaches, on their own time, watched one of two videos - a Centers for Disease Control and Prevention production titled "Heads Up: Concussion in Youth Sports" or a National Federation of State High School Associations video titled "Concussion in Sports - What You Need to Know."
The videos each lasted about 30 minutes. The coaches answered questions during the video and received a certificate upon completion.
Richards said the biggest concern some of his coaches had was liability. Coaches wondered if they would be held responsible if a player suffered a concussion and they missed it.
"I told them it's not about holding anybody responsible," Richards said. "It's just making us aware of potential dangers, what to look for and, if it happens, how to assess it."
He said he hasn't seen any decline in volunteers because of the requirement of watching the video.
"Everyone is in it for the children," he said.
Protecting the children is what the training is about.
Because of the AtlantiCare sessions, Marks now knows what to look for - a lifeless look in the eyes, complaints of nausea or dizziness - when he checks players involved in a collision to see if they suffered a concussion.
If there is any doubt, the player sits the rest of the game and does not return to action until a medical doctor clears him.
"Even if they tell us they're OK, we can see it in their eyes they're not," Marks said. "We automatically shut them down. That's way more important than winning a game."
Richards said, like Marks, he is more aware of the potential for concussions when watching games.
"When you see kids out there and they're playing physical and they take a really hard shot, you look at them closer for the next few minutes," he said. "It's a good thing that it's at the front of our minds."
That's a long way from the days when a coach would have checked on a player with a head injury by holding up two fingers and asking the athlete, "How many fingers do you see?" Coaches back then were quick to dismiss head injuries, saying a player "got his bell rung" or just got "dinged up."
"Anything short of them throwing up, they'd go back in play," Marks said.
That attitude began to change in the past five years, mostly because concussions became a hot topic in the NFL. Several former professional players have come forward to tell of how their lives was adversely affected by head injuries.
A case involving a middle school football player in the state of Washington also drew national attention and increased awareness about the dangers of youth concussions.
Zackery Lystedt, then 13, left in the first half of a 2006 football game with a head injury. He returned to the contest and made a game-saving tackle on the goal line. But the hit caused a brain hemorrhage. He was in and out of a coma for three months and his injury spurred Washington to pass a concussion safety law.
"It (concussion awareness) really changed with the NFL and Lystedt," Rice said. "Once the NFL, with all of its might, power and influence, got onboard then everything changed. Their clout made people stand up."
Atlantic City High School trainer John Ross says the increased awareness can only be a good thing. Ross speaks not only as a trainer but also as a parent. His 12-year-old son, Kyle, plays for the Mays Landing Lakers in the ACJFL.
"I think the parents are happier the coaches are aware of it and know how to look for some of the symptoms," Ross said.
Ross said he was surprised by how often concussions occur on the youth level. At a football game last month, Ross checked on a quarterback, who was tackled from behind causing a whiplash effect to his head.
"I'm seeing a lot more of it at the (ACJFL) varsity level (where 13- and 14-years-olds play)," Ross said. "I think we're much more aware of it now and kids are bigger, faster, stronger than ever now."
Rice said all the publicity and training is working. He said his office has seen 30 to 40 youth athletes with concussions this fall when normally they would have seen two or three.
Rice describes the focus on concussion awareness as a crusade. He said if concussion victims are cared for correctly from the beginning they can heal completely and not be at risk for future problems and more concussions.
"The message is out there," Rice said. "It's great. If you suspect or know somebody has had a problem you hold the kid out until the medical community can take care of it. It's the way it should be."
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