Most of what Bailey McMillian remembers is what he’s seen on film. The actual experience, he says, is only “sketches of parts of the night.”

The helmet-to-helmet hit from a Central Hinds defender and the ensuing trip to the hospital are wiped clean from the mind of the Porters Chapel Academy junior football player.

Three hours are missing from his life.

“I remember waking up three hours later in the hospital and didn’t know where I was,” McMillian said. “I started freaking out. My head was pounding. I couldn’t feel my back. My mom told me what happened. I had a headache and was out for, like, three days. I had to stay in my room with the lights off. It was scary.”

McMillian was diagnosed with a concussion, an injury that once was considered relatively minor but whose long-term effects are finally beginning to be understood. The danger has spread fear and concern through every level of football, but it’s also generated a positive effect.

Through better awareness and understanding of how concussions happen and what they do to the body, there’s a healthy respect for the injury that is changing attitudes toward it.

Whereas players once would have been told to “shake it off” and re-enter the game, they now are held out until symptoms clear. Preseason classes are given to coaches and players about how to recognize concussions and respond to them. New helmet technology is being developed to better protect players against hard hits, and limited-contact practices are becoming commonplace.

In a contact sport like football, concussions might never be eliminated. Through education and awareness, however, coaches and players believe they’re taking steps to minimize them and deal with them when they do occur.

“I think the biggest thing is, the awareness has increased along with technology and being able to understand the possible dangers and cautions. Awareness has really come to the front. People are trying to make all sports as safe as possible,” said Warren Central football coach Josh Morgan. “You didn’t used to hear about them as much. Now people are being more educated about it and being taught the signs and symptoms.

“Coaches now, we’re all CPR and first aid certified,” Morgan said, adding with a chuckle, “Before long, we’ll have to have our doctor’s degree.”

 

An ounce of prevention …

At the high school level, coaches and administrators have taken the approach that the best way to treat concussions is by keeping them from happening in the first place.

In late 2015, the Mississippi High School Activities Association recommended that all of its coaches go through USA Football’s “Heads Up” training program. It’s designed to teach proper tackling technique, as well as other measures to ensure player safety.

Those lessons are augmented with ones to players about how to spot concussion symptoms. The MHSAA has distributed posters and other materials to every school in the state about the dangers and symptoms of concussions. Posters hang on the walls of nearly every school’s fieldhouse or locker room.

“We meet with them before the season and the trainer will talk to them during spring ball, and let them know the seriousness of concussions,” Vicksburg High football coach Marcus Rogers said.

In addition to educating players and coaches, new technology and practice methods are being introduced that could reduce concussions.

Earlier this year, the Ivy League of the NCAA announced it was eliminating tackling during in-season practices. The idea is expected to filter down to the lower levels of football eventually, but many high school coaches say they already do it.

Most teams follow a four-day practice schedule during game week. Monday includes a film review and light workout, and Thursday is a short walkthrough focused on strategy. Tuesday and Wednesday are full practice days, but between a desire to keep players fresh for games, limit unnecessary injuries and time constraints, teams rarely go all-out for very long.

“We go more no-contact than we do full-contact. We eliminated live contact with our ones vs. ones. You want to do that more with the scout team and tackling dummies,” Rogers said. “We get about 90 minutes of good contact a week.”

Protective equipment is another tool for concussion prevention. Tackling dummies help prevent the head-to-head collisions that are the most common source of concussions. Drills that might produce those collisions, like the one-on-one Oklahoma drill, are used infrequently.

Rogers said Vicksburg uses landing mats during some drills to further protect players.

“We have a mat so kids won’t hit their head on the ground,” Rogers said. “That’s where you see a lot of them get hurt. It’s not the hit itself, it’s when they fall and hit their head on that hard ground.”

Football helmets are a primary defense against head injuries. Helmets are usually reconditioned — meaning any damage is repaired and padding is replaced by the manufacturer — every two years.

By law, no helmet can be in service more than 10 years before it is discarded. If a manufacturer deems a helmet too damaged to fix, it is destroyed. New technological advances are also being phased in.

“They’re coming out with facemasks that deflect the blow and push it up. We have some of those,” Morgan said.

Besides education and good equipment, having a trained human element in place is a major asset.

St. Dominic’s Hospital in Jackson, through an outreach program, has provided certified athletic trainers to Warren County’s high school teams as well as others in the Jackson Metro area. Nicole Smith works with Vicksburg and St. Aloysius, while Jared Shore covers Warren Central and Porters Chapel.

The two trainers are able to respond quickly to concussions, as well as other injuries. A concussion diagnosis can only come from an actual physician, but the trainers offer a front line of defense against further injury.

“The biggest thing is for each school to have an on-field trainer. The schools that can’t afford that is the biggest concern,” Morgan said. “That needs to be a discussion. Whether it’s concussions, or heat illness, or whatever, having that trainer here is very, very important.”

 

Treating the injury

Although steps have been taken to minimize concussions, they do still happen in a contact sport like football. On average, Warren County’s high school coaches said they had about two concussions per team last season.

When a hard hit does occur, all of the training springs into action.

The first line of defense is often position coaches or other players. While some concussions are obvious, others can be subtle. Having players on the field watching out for their teammates and pointing out an injury can help get someone to the sideline faster.

“If I see a player and I think they’ve been hit severely and possibly have a concussion, if they don’t come out of the game I’m personally taking them out. Make sure they’re OK and good, and checked by a trainer who’s on the sidelines,” said Ben Brown, a junior offensive lineman at St. Aloysius. “You want to make sure they’re OK. Their parents are up in the stands, too. They don’t want to see their son playing with a concussion. It’s a very serious matter that shouldn’t be taken lightly.”

Porters Chapel Academy quarterback Garrett Hutchins suffered two concussions last season. The first came Sept. 11 against Hillcrest. He was cleared to play the following week against Trinity and suffered another one that left him unconscious for nearly two minutes.

After his first concussion, Hutchins initially tried to return to the huddle. A teammate saw something was wrong and notified coaches and trainers.

“I was in the huddle, trying to get the play, and was stumbling and stuff,” Hutchins said. “Everybody was grabbing my facemask telling me I need to get out of the game. I was telling them I was fine. One of my players called timeout and called the coach over there and they wouldn’t let me go anymore.”

Once a player is pulled from the game, they’re looked over by a trainer or doctor on the sideline. Smith said trainers look for common concussion symptoms — headache, dizziness, blurred vision, poor balance, loss of consciousness or dilated pupils.

One that’s less visible is also a good indicator, and is where the regular presence of a trainer comes in handy.

“Since I’ve been here for so long, I know my athletes. If their personality changes, a normal kid who’s shy and becomes aggressive, those are all signs and symptoms,” Smith said.

Not every concussion is the same, however. Hutchins lost consciousness for nearly two minutes after taking a blow to the head against Trinity, but was walking around and cognizant following his concussion a week earlier.

Further complicating matters, concussion symptoms can also mirror those of heat exhaustion.

Distinguishing between the two is hard enough, but then there’s another factor to sort through — a player’s competitive fire. A player with a more minor concussion might not be fit to play again that night, but is still aware enough to pass the tests given by trainers to determine their condition.

“Unfortunately, there are kids that will lie to you and you have to play on the cautious side. You’re not going to take that risk with a kid,” Smith said.

Hutchins admitted doing that after his first concussion. A desire to help the team overrode caution and common sense, he said. Instinct also takes over, and a player might respond that he’s OK when in fact he’s not.

“It’s just whatever hits your mind. When you’re in the zone like that, you know the answer you need to give them and then you know the answer that will get you back in the game,” Hutchins said. “Getting taken out with a concussion will be the right thing to do, yes, but at the same time you look out on the field and everybody else is wondering ‘Is he OK? We can win.’ It’s a lot that hits your head quick and you have to decide on.”

Smith said that a good relationship between player and trainer is key in that situation. Knowing that the trainer is looking out for their well-being can mean the difference between a straight answer and a misleading one.

“It’s making them aware,” Smith said. “They know I’m not just here to pull them out for fun or because I’m being mean. They have to know that we’re looking out for them and protecting them. We don’t want them to have a more serious injury than necessary.”

 

The concussion protocol

Of all the recent changes in the approach to concussions, the most dramatic might be the way they’re handled after the injury.

In 2010, the National Federation of High Schools -— a national group that sets policy and competitive rules for most of the country’s state high school associations — passed a rule mandating that any player showing concussion symptoms be removed from a game.

The NFHS rule further stipulated that the player must be cleared by “an appropriate health-care professional” before returning to competition.

In practice, that means any concussed player needs to visit a doctor and pass a series of steps before they can play again.

“We use what’s called the SCAT 3, which is a concussion test, and it grades them out,” Smith said. “If they have any of the symptoms they’re not allowed to go back into a game that day. They have to be evaluated by a professional who knows a lot about concussions. Seven days is usually the minimum before they can get back into a game.”

If a player is diagnosed with a concussion, they enter what is called “the concussion protocol” once they are free of symptoms for at least 24 hours.

The protocol is a five-day process that allows players to do progressively more physical activity.

On day one, they are permitted to do some light aerobic activity such as walking or riding a stationary bike. Resistance training, such as weightlifting, is prohibited.

Day two permits weightlifting and sport-specific activity like running. Non-contact drills are permitted on day three, and they can rejoin full-contact practices on day four.

On day five, if they have not shown any more symptoms and progressed through each stage of the protocol, they are cleared to play in a game.

“The first day we had to walk a mile for 30 minutes. The next day we had to jog for an hour. The next day we had to run for about an hour and a half. And then the next day, if we didn’t have any headaches or symptoms we could go on to the next step,” PCA’s McMillian said. “The last day, we get to run routes and put your helmet on and dress out. Then you work your way up back to normal.”

The protocol ensures that athletes will sit out for at least a week. In many sports that means missing several games, although in football they could be back without missing any since there’s only one game a week in that sport.

“Five years ago, we knew what a concussion was but there wasn’t anything to it. You were out a couple of days and you’re ready to go,” said Wade Patrick, the athletic director and baseball coach at Porters Chapel Academy. “Now it’s usually seven minimum and sometimes two or three weeks depending on the symptoms.”

The concussion protocol is another layer of protection for young athletes. It calls on players, parents, coaches and administrators to all be vigilant and observant of lingering symptoms.

“I think we’re taking the right steps, and the high school association is taking the right steps. The awareness is definitely there,” Warren Central’s Morgan said. “I think sports are safer than they’ve ever been, and football specifically.”

 

The long-term effects

Research into the long-term effects of concussions has really only ramped up in the past few years. A number of NFL and college players have been diagnosed with Chronic Traumatic Encephalopathy, or CTE, a progressive degenerative disease found in people who have had a severe blow to the head.

CTE is believed to be caused by multiple concussions over many years, but has been found in some high school and college players.

“We’ve dealt with concussions, but it’s the third and fourth ones you worry about,” Patrick said. “You worry about all of them, but it’s the repercussions of multiple (concussions). A lot of times you don’t diagnose one or two of them unless you have a doctor or they experience the symptoms of a concussion.”

Other long-term effects of concussions include depression and memory loss.

Concern about those effects, however, varies from person to person. The vast majority of athletes will never play a sport beyond high school, and given the relatively low number of concussions suffered per season, some are more worried about it than others.

St. Al’s Brown, who has committed to play at Ole Miss after he graduates in 2017, seemed to accept it as part of the game as well as a preventable injury. Brown said he has never had a concussion.

“You can’t always prevent it, but you can take steps to make sure it’s treated properly,” he said.

PCA’s McMillian still plays baseball, but said he’s through with football after dealing with his concussion last season.

“I came back two weeks after and I just really didn’t feel for it anymore. I didn’t like getting hit in the head. I didn’t feel comfortable making hits,” McMillian said.

Rogers and Morgan, the coaches at Vicksburg and Warren Central, respectively, both played college football. Rogers played at Jackson State from 1996-2000, and Morgan was an All-Southeastern Conference safety at Mississippi State from 1998-2001.

Neither coach had a concussion during their playing days, and don’t feel like they’ve suffered long-term injuries.

“I saw stars a lot,” Rogers said with a laugh. “I think my mind is intact. My last three years I played tight end, so I didn’t have a lot of collisions.”

Morgan said the increased focus on training, education and prevention leads coaches to error on the side of caution when it comes to concussions.

“Most of the time we make an error and we’re off with it. They don’t have one,” Morgan said.

“Most of the time we think a big lick has been passed, they don’t have them and it’s not a factor at all. We’d rather be safe.”

PCA’s Hutchins had one of the scarier concussion-related experiences imaginable last season. After he was knocked out for the second time against Trinity, Hutchins stopped breathing for a full minute -— and again for 30 seconds in the ambulance on his way to the hospital.

Afterward, the pain continued.

“Getting knocked out like that, my brain shocked my body. I had aches and pains. It hurt to walk, turn my head, anything,” Hutchins said.

Hutchins missed the last five games of the season and still has not been cleared to play football. He did play basketball during the winter and is currently a starter for PCA’s baseball team.

Despite the effects, the sophomore didn’t hesitate when asked if he wanted to play football again.

“Oh yeah,” he said with a smile.