ore than a dozen high-profile college sports programs require football players and other athletes to report teammates they suspect have sustained a concussion, a mandate that could boost detection of head injuries but that some deride as a snitch rule.
The requirement arises from the fact that at least half of college athletes’ concussions go undiagnosed — in some cases because they try to hide their condition to keep playing, according to several studies. Teammates spend more time with each other and are often more trusted than coaches or trainers, so they often know when someone is hurting from an unreported concussion.
“It is a good step forward,” said Zachary Kerr, an epidemiologist at the Datalys Center for Sports Injury Research and Prevention in Indianapolis who has studied college concussion policies. “I think it will pick up some of the concussions that are not identified.”
At least 15 of the 65 colleges in the conferences that compete at the highest level of college sports have a teammate-reporting mandate, according to a STAT examination of the concussion policies of those institutions. In those cases, athletes are required to sign a form acknowledging their obligation to report teammates. None of the policies specifies a punishment for failure to report.
Typical of the forms is the one used by the University of Miami. “If I suspect a teammate has a concussion, I am responsible for reporting the injury to my team physician or athletic trainer,” it reads. The University of Kentucky puts its requirement in bold and underlines the word “responsibility.” North Carolina State University frames the obligation as a matter of an athlete promising to “help protect my teammates by reporting their signs and symptoms to the sports medicine staff immediately.”
At the University of North Carolina, the requirement has helped the medical staff discover concussions that went unreported by the injured athlete, said Dr. Mario Ciocca, the director of sports medicine at the school.
In one case, a football player suffered a concussion during a touchdown drive but the injury was not detected by coaches and medical staff, he said. It was another player who alerted Ciocca to the situation.
“One of the players came up to me and said you need to check him out, he doesn’t seem right,” Ciocca said. When the doctor spoke to the player, the athlete had no memory of the prior drive. “He asked me for the playbook so he could read it and go back out there,” the team doctor recalled.
“It was very helpful,” Ciocca said of the teammate summoning help for the concussed player. “At some point it would been discovered — he could have started running the wrong way — but he still would have been out there.”
Suffering a second concussion soon after a first can result in permanently disabling effects, according to the American Association of Neurological Surgeons.
Getting athletes to buy into the idea of reporting teammates could be difficult. Athletes could be accused of violating the trust or confidences of teammates. In other cases, they could be raising concerns about a teammate who plays the same position or competes for playing time. A study last year of athletes on 19 college teams found that only about half said they would alert a coach or athletic trainer if they suspected a teammate was suffering from a concussion.
A survey by University of Dayton researchers of nearly 200 college athletes playing contact sports at the Division 1 level found that 60 percent suspected a teammate had suffered a concussion during their most recent season. Of those who thought a teammate might have been concussed, only half had reported their suspicion. Many said they didn’t notify anyone because they believed the teammate had self-reported the injury. But others said they failed to do so because they didn’t want to “let down teammates” or be the reason they were pulled from a game or practice.
Christine Baugh, a Harvard University researcher who has studied concussion reporting behavior, raised another issue. She said the mandate may place an unfair burden on athletes who are not trained to diagnose concussions.
“An obvious concern is a school trying to shift some sort of responsibility or liability to the teammates of the injured athlete,” she said. “It is concerning to think there might be a case where a teammate doesn’t indicate a medical concern for someone on the team who sustained an injury. What comes next? Is there some kind of repercussion for them?”
Baugh said concussion symptoms are nonspecific, such as headaches. She said headaches could be caused by many different things, from dehydration to stress. “How is one teammate to know,” she said.
When the National Football League floated the idea of teammate reporting in 2009, some current and former players immediately rejected the idea by saying they were not “snitches” or not willing to “rat” out teammates. The league does not mandate such reporting. In January, however, league medical officials said the NFL was undergoing a culture change, with team doctors observing a recent increase in players reporting suspected concussions among teammates.
The governing body of college athletics, the National Collegiate Athletic Association, leaves it up to member schools to decide whether teammates should be required to report cases when they suspect another athlete has been concussed.
“We decided on our own, and it only makes sense,” said Iowa State University spokesman Michael Green. He said athletes have stepped forward to report that teammates may have suffered a concussion. In all those cases, however, the medical staff had already identified the potential injury, he said.