Longtime Wasilla High team doctor talks concussion protocol

WASILLA — During a recent high school basketball season, Dr. Dan Larson asked about a dozen players on the Wasilla Warriors boys’ team to raise their hand if they had ever suffered a concussion.

“Six hands went up,” Larson said recently.

Larson, a longtime doctor of chiropractic in Wasilla, has worked with Warriors athletics for more than two decades, serving as a team doctor and athletic trainer. During his time on the sidelines, and through the evolution of care of student-athletes, a continued focus has been placed on a particular concern.

Concussions.

“It’s the number one injury I deal with now,” Larson said.

Larson, who spends the bulk of his time working with the Wasilla football and basketball programs, said if he were to make a list of injuries Wasilla athletes face each year, concussions would top the list.

Knees, ankles, elbows, teeth, wrists, fingers.

“Put everything in its own category, put concussions in its own category, and concussions would outnumber all of the other injuries,” Larson said. “By far it’s the most prevalent injury we deal with it.”

Part of it is simple. Education and awareness. Twenty years ago, Larson said, information team doctors and coaches have access to now was not available. Potential long-term effects were not known. Coaches and team doctors did not identify potential concussions, like they can now.

Education led to strict protocol. Larson has been closely involved concussion awareness and the implementation of protocol of care at both the school district and state levels. Larson said athletic trainers, coaches and school officials now follow very strict guidelines. It’s all about protecting the student-athlete, Larson said.

Larson also stressed that concussions are not exclusive to hard contact sports such as football or hockey.

“You need to be aware in all sports,” Larson said.

And it’s not always obvious. It’s not just the football player who is disoriented and staggers to the wrong huddle. Larson said training staff looks for changes in behavior. Players on the field also help to alert training staff if a teammate is acting differently.

During the football and basketball seasons, Larson said he treated about a dozen Wasilla athletes who suffered a concussion during the current school year. Larson said authorized officials take multiple steps to diagnose a concussion. If a student-athlete is diagnosed, there is another process, with strict guidelines, to determine when the athlete is ready to return to their sport.

A possible concussion

Larson said, according to current state law, if a student-athlete shows any sign of a potential concussion, the athlete must be removed from play immediately. The athlete cannot return to play until cleared by a certified medical professional.

The exception, Larson said, is if the athlete loses consciousness at any time. At that point, the athlete must be properly stabilized and 911 is called. Emergency personal will transfer the athlete by ambulance to the hospital.

“Concussions are frequently associated with neck injury,” Larson said.

If the athlete remains conscious, the player is brought to the sideline. Larson said the SCAT 5 (Sport Concussion Assessment Tool) is used to diagnose a concussion.

“It’s a specific set of diagnostic questions,” Larson said.

According to information made available by the Jefferson Comprehensive Concussion Center, jeffersonconcussion.com, the system includes a series of assessments. The first step is looking for obvious signs, the “red flags,” such as neck pain, double vision, headache, nausea and sensitively to light or sound. The second step includes noticeable signs, such as lack of balance or coordination, disorientation or confusion.

The third step involves basic questions. Where are you? What half is it? Did your team win its last game?

Larson said he also grades symptoms, rating them from zero to six, with six the most severe. Memory is also tested. Larson said gives the athlete a group of words to remember and repeat.

“If I am suspicious at all, I remove them from play for 24 hours,” Larson said.

After 24 hours, an athlete with a potential concussion must see Larson or another medical official. If symptoms progress, Larson directs the athlete to go to the emergency room.

Returning from a concussion

After an athlete is diagnosed with a concussion, Larson follows the Return to Play Protocol, another set of strict guidelines.

The process begins when the athlete is symptom-free for 24 hours. The first step includes 15 minutes of light aerobic activity, according to paperwork supplied by Larson. The following step involves 30 minutes of light to moderate activity, and the third step includes 30 minutes of moderate to heavy aerobic activity. There is no resistance training allowed during the first three steps.

The duration of activity increases with each step. Athletes can return to practice, with limited participation, on the fifth step, and return to full practice on the sixth step.

Athletes can be medically cleared after a seventh. Each step must be documented by the certified medical professional. The process typically takes six to seven days to complete, after there are no more concussion symptoms, Larson said. If any symptoms return, the process restarts.

Larson said an athlete’s medical history is also taken into account.

“The evidence is so strong, people are permanently damaged by head trauma,” Larson said. ”Two concussions in the same year, you would be done by my protocol.”

Larson said if an athlete suffers three concussions in two years, the athlete should not return to the sport.

The Mat-Su Borough School District also requires a neurological baseline test for each athlete. The results are used when monitoring athletes who have suffered a concussion.

Education

Larson said concussion education and awareness continues to progress. Every coach is required to go through concussion protocol training. All athletic trainers and team medical stuff must be certified every two years to treat concussions.

“We’ve come a long way with the ability to diagnose,” Larson said.

Contact Mat-Su Valley Frontiersman sports editor Jeremiah Bartz at sports@frontiersman.com.