Everybody just thought that the helmets would protect you.

-Ben Holman, CHS Graduate

On Sept. 30, during the third quarter of a Pike County High School football game, 16-year-old linebacker Dylan Thomas was carried off of the sidelines on a stretcher.

According to a CNN article, Thomas was wearing a new Safety Equipment Institute-certified Riddell SpeedFlex helmet, and after reviewing game footage, the Georgia High School Association determined there was no evidence he had sustained a major injury during the game.

Yet two days later, Thomas died of cardiac arrest caused by brain trauma in an Atlanta hospital.

Thomas’ story is not unique. A study by the National Center for Catastrophic Sports Injury Research found that of the 20 high school and college-level football players who died in 2017, four deaths were directly attributed to injuries sustained during practices and games. Three of these injuries occurred to the brain.

Despite the research pointing to potential dangers of the sport, for many, it remains an integral piece of the American experience. Football’s influence in the nation’s culture is significant. However, at CHS, football participation has been steadily decreasing over the last decade, and the team is currently almost half the size of what it was during the 2014-15 season. Many athletes are turning to other sports, such as soccer–which has over 90 players this year– where there is less stigma about the dangers and potential for injuries.

With 12 graduating seniors this year, there is concern that the athletic department will not have the numbers to support a football program into the future. The varsity team has no feeder program, like the JV and freshman teams other sports have – Clayton football is appearing to have a dim future.

“Across the country, football participation numbers are down,” CHS athletic director Bob Bone said. “If there are things we can do to increase the safety level, then that’s what we’re going to try to do. And so long-term we hope it makes people feel better about participating in football.”

“Football is a violent game. There is no way to get around that. But if there are things out there that we can due to increase the safety level, that’s what we are going to do,” Bone said.

For several years, the athletic department at CHS has been brainstorming and researching ways they could increase the safety of high school sports, with a focus on football.

Last year, the department found the Riddell Insite Training Tool, technology with helmet inserts that measures the impact a player receives every time he suffers a hit to their head.

The athletic department conducted more research regarding the Insite Training Tool and talked with local high schools that already had the technology. Head coach of the CHS varsity football team, Linwood Barnes, also knew about the tool and began discussions with the athletic department and administration about investing in the helmet inserts.

“The product was going into its second generation this year, which we felt was important because [Riddell] has gotten a lot of the bugs and kinks out of it,” Bone said. “And we felt like for the safety of our kids, this was a good safety factor for them.”

There are three parts of the Insite Training Tool. First is the helmet sensor pad, which is an insert inside the helmet. There are four sensors in each helmet, one on each side, the crown and the back of the helmet. Whenever there is a strong impact, or the force of an impact exceeds the pre-set threshold value on a sensor, the technology will signal an alert to the alert monitor, the second part of the Insite Training Tool.

The alert monitor is a remote that Kristen Saunders, the CHS athletic trainer, holds during practices and games. When the remote receives an alert, it will show the name of the player and the time that the impact occurred.

Before the program had this technology, Saunders tried to watch every hit during practices and games, which was a difficult task for a single person.

“Being by myself [on the field or sideline] is hard, especially when there’s different tackling drills going on. The linebackers practice one side of the field, the D-lines are on the other side and the safeties are elsewhere. So when the players are all spread out on the field, it’s hard to watch each drill, so the new technology is just another tool to help us,” Saunders said.

The third part of the Insite Training Tool is an online computer software that allows coaches to analyze the hits each player receives or takes to the head. After each game or practice, the coaching staff will plug the remote into a computer, and the computer will show the coaches each impact that happened that day, what drill it happened in, where on the helmet the impact occurred and the intensity of the impact.

By implementing this technology into the helmets, the Clayton football program has been able to increase safety and enforce better tackling and hitting techniques.

“It gives me more insight,” Barnes said. “If someone gets a head injury during tackling, I know we need to change that up and try to figure out what we were doing wrong. Instead of having two sets of eyes, I have 30 or 40 sets of eyes because it monitors everybody.”

Bone has also expressed his appreciation for the Riddell Insite Tool’s role in improved tackling technique.

“If a kid hit somebody and he has lowered his head and the impact is on the front part of the helmet then that will show up on on the readout. We’re then able to make adjustments in the coaching. So when you put everything together, [the Riddell Insight Training Tool] increases safety and acts as a teaching tool,” Bone said.

However, the helmets are not capable of reporting the severity of an injury a player receives as a result of a hit.

“Helmet accelerometers give you useful information but they don’t tell you if you have a concussion,” Dr. Roseanne Naunheim, associate professor of emergency medicine for Washington University in St. Louis at Barnes Jewish Hospital said. “They tell you how hard you’ve been hit, but don’t tell you what’s going on inside the brain.”

Because of this, when she recieves an alert, Saunders will pull that player out of the game or practice and will conduct an examination to determine if the player has been injured by the high impact hit. She receives on average two-to-three alerts per game and one-to-two each week of practice.

If the player is suspected of having a concussion, he must be cleared by a physician before they can return to play. From there, a player must be symptom-free for a full day before he can begin the five-day procedure for returning to the field. On the first day, the player undergoes a light cardio workout, which increases to a more strenuous workout on the second day. By the third day, a player can participate in half of a non-contact practice. After four days, he can once again fully participate in practices, and by the fifth day, can return to the field during games. According to Saunders, if at any point during the process a player shows symptoms, he must return to step one.

Even at the national level, the NFL has made efforts to make football a safer game. In March, before the 2018-19 season, the organization instituted a rule that would penalize a player for lowering his head to initiate a hit with an opposing player. This sets a precedent for safer tackling across all football levels.

“Whenever there are rule changes in the NFL, the changes will trickle down to college football and then the high school level,” Saunders said.

Initially, the team experienced an adjustment period with the new helmets. At the beginning of the season, Saunders was getting many more alerts than she does now. However, this new technology has helped the players develop safer tackling techniques.

“The guys were made more aware they need to stop leading with their heads. So now they’re just more aware of how to tackle and they’re not leading with their head anymore,” Saunders said.

Although Clayton is using the second generation of the Insite Tool, Saunders has noticed some faults in the technology.

She said, “I’ve had alerts and then the player comes off and they’re fine. And then I’ve also had a player come off on the sideline saying that he has a headache and I didn’t have an alert.”

Even though high school and college football programs across the country use helmet accelerometers, there are some medical experts who do not think the Insite Tool technology is worth the investment.

“In an accelerometer helmet, the accelerometer is just an extra bell and whistle that is unnecessary at this point and may led to more confusion and worry than help for a lot of people,” Mark Halstead, director of the Washington University sports concussion program, said. “I would not recommend [accelerometer helmets] at this point … They are more utilized in a research setting than they are to help someone on the field right now. Helmets still serve a purpose, like preventing bleeds in the brain or skull fractures, but they don’t do a very good job reducing concussions.”

“We really hope that our students and our parents too understand that we’re trying to do everything we can to be as safe as possible. I think a big concern is the concussions. Obviously we can’t take that concern away, but maybe we can soften that a little bit. We’re doing everything we can,” Bone said.

“Some kids never return to normal,” Naunheim said.

Concussions and traumatic brain injury (TBI) have become synonymous with American football. After a player’s first concussion, he or she become three times more likely to receive a second and eight times more likely to receive a third.

A concussion, a mild TBI, is the result of blunt trauma, occurring when someone receives a blow to the head. The rotational movement of the brain inside of the skull during this period causes the brain to hit the interior of the skull, bruising at points of impact. The brain experiences a shearing of axons that contributes to decreased cell function and can cause loss of consciousness.

“There are about 2,000,000 visits for concussions in pediatrics per year, but we don’t actually know how many occur because most people don’t come in,” Naunheim said.

While these cannot be solely attributed to football, according to the Brain Injury Research Institute, 20 percent of high school football players will suffer a concussion at some point during their careers. (Note: The print issue of this story incorrectly stated that concussions were the number one cause of death in children and young adults, not Traumatic Brain Injuries. Concussions are a form of Traumatic Brain Injury. Motor vehicle accidents are the number one cause of TBIs.)

Players who suffer concussions typically experience post-impact symptoms. In the short term, these include headaches, loss of memory and confusion.

“If you talk to someone with a concussion, they will ask ‘what happened’. You’ll explain it to them, but then five minutes later they will turn and ask ‘what happened’ again.” Naunheim said.

However, long term post-impact symptoms can be severe, with the potential to leave lifelong impairments. Treatment and management of these symptoms have evolved significantly as neuroscience in this field has developed.

“When I was doing my training it used to be that we would actually allow athletes to go back to play after 15 minutes if their symptoms went away,” Dr. Mark Halstead, director of the sports concussion program for Washington University said.

Currently, the Missouri State High School Activities Association (MSHSAA) requires a standard five-day return-to-play procedure following the diagnosis of a concussion. Clayton not only follows the MSHSAA procedure, but uses Riddell’s InSite accelerometer technology to keep players safer.

“There’s actually some very sophisticated monitors that they use for research for concussions that they put into helmets to determine if there is a certain g-force when a hit happens that causes a concussion,” Halstead said. “The problem is that there’s not a high level of a g-force when a concussion occurs.”

As a result, this presents limitations to Riddell’s technology. The g-force measured can not be a conclusive factor in determining a brain injury because TBI can be present at a hit that does not necessarily reach the sensor threshold. However, electroencephalography can be used to better determine if a player has a concussion. Electroenclephlagrams (EEG) measure electricity in a brain to predict if someone has a TBI.

According to Naunheim, who works with a company called brainscope to compare thousands of EEGs, the measurements produce a number on a scale of 0-100 correlating to the likelihood of a concussion.

“When you are asleep, or if you are using drugs, those waves change. And also if you’re concussed, your brain waves slow and the difference in connection between one electrode and the next takes longer,” Naunheim said.

One of the biggest health concerns in football at the professional level is chronic traumatic encephalopathy (CTE). This degenerative disease results from repeated concussions, TBIs and blows to the head in general. A brain suffering from CTE will lose mass over time, leading to memory loss, erratic behavior and impaired judgment in a player.

However, there is little evidence this disease has an impact on high school football. A study by the Mayo Clinic revealed that there was no increased risk of dementia, Parkinson disease or ALS among adults who had played football in high school when compared to non-football playing colleagues.

Although often overlooked, non-head injuries can greatly impact a student’s health and performance in the school environment. Broken bones and sprained ankles often require time away from school to deal with, thus potentially causing a student to miss valuable educational time. A student could also receive an injury that could more directly impact a student’s schoolwork, such as a broken hand that could hinder notetaking or testing.

“There’s a chance that someone could go out there and they could have a really serious injury to their chest and they can die from that. Or there’s a risk that they tear their ACL and maybe never get back to sports,” Halstead said.

According to Naunheim, there is still much that medical professionals do not know about the impact football has on players. However, new research continues to bring new issues to light.

“It’s like smoking when my parents were growing up. You learn a lot over time, and what seems fairly straightforward and matter-of-fact now, there was a learning process that went into that,” Holman said. “Everybody just thought that the helmets would protect you.”