Ted Bolleter dove for the ball coming hard his way—a reflex, as much as anything else, for the then-17-year-old goalkeeper playing in a Santa Fe men's soccer league. He had one hand on it already when, breaking the rules of the sport, a player on the opposing team kicked the ball into his head.
Bolleter knows he got a concussion that day. But "they basically gave me smelling salts till I woke up, see if you're dizzy and, you know, 'how many fingers do you see?,'" he tells SFR. "And then rest for five minutes and go back out there."
A lot has changed since that day in 1983, but a close analysis by SFR of how schools respond to youth concussions in sports around the state has found that too much has remained the same.
Twenty-seven years after Bolleter's concussion, the state Legislature adopted the first head injury protocol for school districts. The School Athlete Head Injury Safety Protocols law, passed in 2010, came amid a nationwide push to protect young peoples' brains, especially in football, as research barged into the public discourse linking sports-driven concussions to brain diseases and other problems.
But SFR's analysis found that, a decade later, there remains a lack of uniformity and enforcement among school districts in even developing head injury protocols that give student athletes the best chance of recovery.
The law, spearheaded by longtime state Sen. Michael Sanchez, D-Belen, was designed to empower the New Mexico Activities Association (NMAA) to require school districts to develop their own head injury plans based on the unique needs of their students. When symptoms of a concussion do occur, the law directs coaches to follow the district's protocols.
However, it appears few school districts have developed head injury protocols that meet the standard set out in state law. SFR surveyed all 89 school districts in the state beginning in August; 49 answered our questions in full or in part by presstime.
Of those, just five districts have developed their own head injury guidelines, including Socorro, Rio Rancho, Silver, Los Lunas and Albuquerque school districts. Santa Fe Public Schools is not one of them.
Only 10, including Santa Fe Public Schools, say they have adopted or created return-to-learn policies, which help student athletes gradually return to class after concussion symptoms—a key measure in ensuring proper recovery, according to experts interviewed by SFR.
And among the districts that responded, just five have policies to avert the long-term risk of multiple concussions or subconcussive hits, which some researchers suggest may lead to brain disease. These policies require students to stop participating in sports after three to four concussions.
Youth sports are producing concussions at alarming rates.
Consider: 16 school districts provided SFR with five years' worth of concussion figures. The total: 945 concussions, and that's from fewer than 20% of the state's school districts.
It's not clear how seriously the state and its schools are taking the issue. The law stops short of telling a state agency, such as the Public Education Department or the state Health Department, to track concussion numbers or enforce its requirements. But experts say that when it comes to youth sports concussions, officials don't ask questions if they're scared of the potential answers.
Dr. Dawn Comstock, a professor of epidemiology at the University of Colorado's School of Public Health, tells SFR that meticulous analysis of information is vitally important in preventing concussions and understanding why they happen.
"We should have data-driven discussions and we should be making evidence-based decisions," Comstock says.
No one’s watching
The biggest gap in New Mexico's youth concussion protocol law is that it lacks an enforcement mechanism. It's unclear how much oversight there is of districts' operations by the NMAA, which also has its own bylaws districts must abide by.
The organization limits the amount of time athletes in contact sports like football can practice in full gear and with full contact and also educates athletic directors and coaches on the symptoms of a concussion, says Executive Director Sally Marquez during a phone interview.
But when asked how the NMAA is enforcing its bylaws, Marquez tells SFR she doesn't "need to answer that." When asked if the NMAA's bylaws and the head injury law help avert multiple concussions for a student athlete, Marquez also refused to answer.
Sanchez, the former state Senate powerhouse who helped write the state head injury protocol, envisioned NMAA's role with more responsibility.
"I was hoping that the NMAA and those in charge of our athletics in the state of New Mexico would come up with the process that would be statewide instead of each school individually figuring out a protocol," Sanchez says. "It should be universal across the state… It should all be the same for every single kid, regardless. But I don't think that's happened."
The lack of enforcement is also something that disturbs Comstock.
"Every single state plus DC had passed some form of concussion legislation by 2013," Comstock says. "That's astronomically fast compared to other public health issues… It's fascinating that it happened so quickly. And yet, not a single state has any enforcement arm to their legislation."
In replying to SFR, some districts did not mention the state law at all in their answers.
State law instructs districts to create their own head injury protocols. But when SFR surveyed them about their policies, most districts cite the NMAA. Few have guidelines unique to their districts.
In regards to return-to-learn, most districts say they follow NMAA protocols. But neither NMAA nor the legislation have any official return-to-learn requirements.
That's something Sanchez wishes he had included in the original bill.
"In hindsight, I wish we would have thought about [return-to-learn] as opposed to just saying something to the effect about 'keep him out [of play] for a certain amount of time,' because I think it's very important," Sanchez says.
Back to class
Researchers and the federal Centers for Disease Control and Prevention agree that student athletes need time to heal both off the field and out of the classroom after concussions.
After a concussion, it is "critical" that the athlete gets time to rest, according to the CDC. Both cognitive and physical strain can take up a brain's energy that should be spent on healing. A concussion can also affect a student's ability to concentrate and remember things, as well as bring on increased irritability, sadness and impulsive behavior in the classroom.
The CDC recommends an approach to return-to-learn that involves a school network: parents, teachers, administration, coaches, medical professionals, a school nurse and the students themselves.
The problem is, only ten New Mexico school districts, including Santa Fe Public Schools, say they have adopted an already existing return-to-learn program or have created their own system, either formally or informally.
The school districts that do not currently have a return-to-learn program say it's not required by either state law or NMAA bylaws.
Dr. Monica Vavilala, a professor of anesthesiology and pediatrics at the University of Washington and director of the Harborview Injury Prevention and Research Center, conducts research on concussion protocols for high school students in Washington. She has also published research on variations in state laws governing return-to-learn policies following a concussion.
According to Vavilala, most schools do not have a robust return-to-learn program because of a lack of resources. Unfortunately, she believes that also contributes to the chronic problem of concussions being underreported.
"Let's say schools suddenly figure out that there's a lot of concussions happening, then they're left with the issue of 'what do we do about it?'" Vavilala says. "Then there's the pressure between finding a problem and needing to develop a solution and needing to find resources to develop that solution."
Vavilala says many school districts are not equipped to both pay for and run a comprehensive tracking program for student athletes. To potentially solve that issue, her work is now focused on developing a return-to-learn program that tracks students through the process.
"Because we don't have a law either in Washington state around [return-to-learn] and because we don't have funding, we developed a program that can be administered relatively inexpensively and we just call it the Return to Learn Program," Vavilala tells SFR. "Students are encouraged to report their symptoms and they're tracked for four weeks."
SFPS Assistant Superintendent Hilario "Larry" Chavez tells SFR that his district has a return-to-learn protocol only for what the district calls the most severe cases. The athletic trainer on site confirms the concussion and administration moves ahead with the return-to-learn policy.
SFPS is also one of the few school districts that says it tracks and analyzes concussion numbers by sport.
"[The numbers] are definitely analyzed and reviewed because it does come into play when you're starting to make decisions," Chavez says. "Are we replacing facilities? Is it equipment that needs to be upgraded? Is it our coaches that need better education?… If we see an uptick, it could lead into a different avenue of how we're going to provide that support."
SFR is not the first to look deeper into the concussion landscape in school districts.
The Governor's Commission on Disability contracted with the University of New Mexico Health Sciences Center Brain and Behavioral Institute in 2014. In partnership, they conducted a statewide survey of school districts on head injury protocols. The results of the survey revealed that fewer than 40% of schools had athletic trainers, more than 50% of the schools said they did not have the resources to manage concussions and more than 70% said they needed better training and more resources, according to reporting by Las Cruces Sun News.
Tracking the hits
While tracking is not required by state law or NMAA bylaws, experts in head injury prevention and protocol believe data is the only way to know whether student athletes are safe and current protocol is working.
Comstock focuses much of her research on the epidemiology of sports-related injuries among children and adolescents and how to prevent them.
She also founded and runs the High School Sports-Related Injury Surveillance System, which tracks nationwide concussion rates from high schools. She says creating head injury interventions based on an analysis of data are necessary to protect student athletes.
"We should be making decisions about the health and safety of young athletes based on data," Comstock says. "Then anytime you make a change, anytime you do any kind of intervention because you think it's going to improve health and safety, you need to monitor and evaluate that."
Without tracking, there is also no way for coaches, medical professionals, parents and administrators to know whether a student has had multiple concussions within a given timeframe. Multiple traumatic brain injuries, or TBIs, could lead to Alzheimer's, epilepsy and other brain diseases over time, while repeated hits to the head in a short period of time could even be fatal.
But tracking is not happening for the most part. Many school districts said they do not track concussions because they don't have the resources to do so.
Comstock says that's not a valid excuse.
"Every single school…tracks a whole bunch of stuff because they're required to do it," Comstock says. "Concussions just haven't risen to the level of importance to make them do it yet… So that right there belies their contention that they just don't have the bandwidth to collect and report data. They actually are doing it already. They just haven't made the decision that collecting and reporting concussions is important enough for them to do so. And it's up to you whether you want to think that this is a bottom up or a bottom down problem."
Athletic trainers make great eyes
One of the best ways to spot concussion symptoms in student athletes and track concussion numbers is by employing athletic trainers, according to an analysis by InvestigateWest, Pamplin Media Group and Reveal. They reviewed return-to-play concussion records from high schools across Washington state and found that schools with athletic trainers tend to screen more athletes for concussions and better document the students' path to recovery.
Their investigation echoes a study led by the University of Colorado that found schools with athletic trainers were better at spotting concussions and had lower recurring injury rates.
SFR asked for individual concussion reports from SFPS to dive deeper into the issue. SFPS denied the request, citing medical privacy, despite SFR's suggestion to redact all personal information and only look at the students as numbers to analyze concussion protocol and multiple concussions.
In New Mexico, the trainer landscape does not look filled out. Of the school districts that answered, only 15 employ athletic trainers full or part time. Of those, only six school districts had trainers at contact sports games on the sidelines and available during practices at least some of the time.
At SFPS, athletic trainers are contracted through Christus St. Vincent. Chavez says they are an integral part of the athletic department because during practices and games, the coach's "job at that time is to coach and instruct. It's our responsibility to provide that extra layer of safety."
Only eight states in the country have return-to-learn laws, but all 50 states have some type of head injury legislation on the books. The states passed the laws after the dangers of multiple concussions came into the mainstream. Chronic traumatic encephalopathy and other degenerative brain diseases became household names after researchers linked them to repeated hits to the head.
So far, lawmakers are not planning to address return-to-learn or make other amendments to the rules in the current legislative session. Marquez says the NMAA would "work with anybody," but she says she has not heard from school district officials with concerns over the state law.
Vavilala, who focuses her career on testing and improving head injury protocols, hopes that in a couple of years her Return to Learn Program will be disseminated across the country and "get the kids who are better back to the classroom faster and the kids who really need support referred appropriately."
For Comstock, she also hopes that return to learn protocols will become more mainstream to protect student athletes.
"We were late to the game on that one unfortunately," Comstock says. "The CDC initially dropped the ball on return-to-school. Now most people say that the truly best law would also address return-to-learn."
Of the 89 school districts in New Mexico, 49 responded to SFR's request for information about compliance with the state law on concussions over the last five school years.
Among them were 21 that track concussions, though none of the districts provide those numbers publicly in their own communities. A total of 945 concussions were reported.
The districts with the highest reported numbers are:
Aztec – 116 (2015-19 school years)
Belen – 47 (2017-18 school year)
Bloomfield – 96 (2015-19 school years)
Clovis – 118 (2017-19 school years)
Hobbs – 82 (2015-19 school years)
Silver – 134 (2014-19 school years)
Here's the last four years of concussion data from the Santa Fe Public Schools:
Capital High School
2018–19: 7 (3 in football, 2 soccer, 1 wrestling, 1 basketball)
2019–2020: 5 (3 in football, 2 in girls soccer)
Santa Fe High School
2018–19: 5 (1 in football, 1 soccer, 2 wrestling, 1 cheer)
2019–20: 9 (5 in football, 2 soccer, 2 in cheer)
WHAT THE STATE LAW REQUIRES:
- Remove athlete immediately from sport if there are symptoms of a concussion
- Coaches, parents and athletes need to be officially educated on signs and risks of a concussion
- Athletes can’t return to play less than 10 days after symptoms of a concussion—longer than 10 days if symptoms persist
- A medical professional has to release an athlete to return to play
- School districts must develop their own head injury guidelines
- Coaches must follow the district’s head injury protocol
- Coaches must watch athletes for signs of a concussion after returning to play
WHAT’S NOT HAPPENING?
- Only five districts of those that replied to SFR have developed their own head injury guidelines for the district, per state law
- Only 10, including Santa Fe Public Schools, say they have adopted or created a return-to-learn policy, which helps student athletes gradually return to class after concussion symptoms
- Only five schools have policies to avert the long-term risk of multiple concussions or subconcussive hits, which some researchers suggest may lead to brain disease. These policies vary, stopping students from participating in sports after three or four concussions
This story was completed with information from Reveal's Reporting Networks.