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Longtime athletic trainer removed from position at Winters Mill

Longtime athletic trainer removed from position at Winters Mill
Trainer Paul Welliver examines an injured wrestler in February 2005. (TIMES FILE PHOTO , Carroll County Times)

The only athletic trainer in Winters Mill High School history said he was removed from his position for refusing to begin protocol that could send certain student-athletes back to competition sooner than the time he recommended after the athletes sustained one or more concussions.

Paul Welliver, a certified athletic trainer for 31 years and Winters Mill's trainer since its fall 2002 opening, was removed from his position starting Feb. 13.

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The Carroll County Public Schools Supervisor of Athletics Jim Rodriguez and Winters Mill High School Principal Eric King told Welliver's boss at Maryland SportsCare & Rehab that they did not want him to continue his position at Winters Mill, according to Welliver. After 10 years as the school's athletic trainer, his last day was Feb. 12.

Rodriguez was out of town Thursday and could not be reached for comment and King would not speak specifically about the situation. Rodriguez serves as liaison between the school system and Maryland SportsCare & Rehab, the company contracted to provide the athletic trainers to county high schools.

Welliver said on four different occasions in the last 18 months, he refused to begin the protocol that is meant to gradually release student-athletes back into sports participation after a concussion. The protocol, also known as Return to Play, is supposed to begin once a student-athlete returns a medical clearance form after their injury has been classified as a concussion.

A concussion is a type of traumatic brain injury caused by a bump, blow or jolt to the head that can change the way a brain normally works, according to the Centers for Disease Control and Prevention. Concussions can also occur from a blow to the body that causes the head to move rapidly back and forth. Even what seems to be mild bump or blow to the head can be serious, according to the CDC.

"I refused to start the protocol Return to Play because I didn't want them to return to play," Welliver said.

He said the athletic trainer has to sign off on a student-athlete's return to full contact and competition following a diagnosed concussion.

Welliver's refusal to start the protocol all four times was because he was concerned about the safety of the student-athletes, he said. He is worried about their short- and long-term health, he said.

"There are times when I do not believe they should return to the sport," Welliver said. "It is not safe."

When people sustain one or more concussions, the incidents exponentially grow in seriousness, he said. Some side effects of concussions include depression, headaches and the inability to concentrate. They are at greater risk for future concussions with much less force, he said.

According to the CDC, a repeat concussion that occurs before the brain recovers from the first - usually within a short period of time such as hours, days or weeks - can slow recovery or increase the likelihood of having long-term problems. In rare cases, repeat concussions can result in brain swelling, permanent brain damage and even death.

In at least one of the cases, a student-athlete missed multiple days of class as a result of the concussions, according to Welliver.

"I treat all those athletes like they are my children," he said. "Sometimes I spend more time with other people's children than my own."

After being told of his removal, he posted a message on Facebook explaining the circumstances surrounding his departure. One of his posts that explained why he refused to start the protocol with certain athletes received more than 850 "likes," 188 comments of encouragement and 76 shares, as of 9 p.m. Thursday.

"I take into account many factors, including the number and severity of previous injuries and the age and grade of the student," he wrote on Facebook. "It would be much easier to go along with the pressure of returning the student A.S.A.P., but I have seen way too many poor outcomes after multiple head injuries."

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Many of the people leaving comments praised Welliver for doing what they consider to be the right thing and some suggested that his actions should inspire policy changes.

Stephen Speck, Athletic Director and Facilities Coordinator at Winters Mill, said upon suffering a head or neck injury, a student-athlete is given a form titled, "Notification of Probable Head Injury for Interscholastic Athletics," which they are asked to take to their doctor, physician's assistant or nurse practitioner for a signature.

That medical professional then analyzes the athlete and diagnoses whether a concussion is present. If it is decided that a concussion does exist, the student-athlete is given a follow-up form called "Medical Clearance for Gradual Return to Sports Participation Following Concussion" and asked to visit the doctor again to obtain a signature, he said.

The gradual release back to sports participation Return to Play protocol cannot begin until a medical professional has formally cleared the student-athlete with the second form. Licensed athletic trainers oversee the medical clearance for return to sports participation, Speck said.

"It can last as long as that Licensed Athletic Trainer deems necessary based on his or her analysis and assessment," Speck said.

That responsibility is given to the athletic trainer because they have a familiarity with student-athletes and see them on a daily basis, he said.

There is a series of steps that are to be followed during the gradual return to play, where the student-athletes go through light activity, then moderate activity and then two tiers of heavy activity. The beginning stage is mainly conditioning exercises and it moves on to more sport-specific exercises later in the process, Speck said.

"Within the steps, there's a specific set of criteria of prescribed activity to which the student athlete is to be subjected," Speck said.

Assistant Superintendent of Instruction Steve Johnson said he believes there has always been a protocol followed to gradually return students to playing sports after a concussion, but new concussion management laws came out about two years ago.

The state came out with a model policy, and based on that, the school system developed its own guidelines with the help of medical professionals. Student-athletes now go through a pre-concussion test at the beginning of their season, which is compared to their results on a post-concussion test taken after sustaining a concussion.

Both tests are administered by athletic trainers and analyzed by a neuropsychologist, Johnson said.

"We're pretty confident that what we have in place is in the best protection of our student-athletes," Johnson said.

After the second form is signed by a doctor, physician's assistant or nurse practitioner, the return to play protocol is supposed to last a minimum of five days, but could last indefinitely, Speck said. The length of time is determined through following that protocol, he said.

The expectation of Licensed Athletic Trainers in Carroll County Public Schools is that, following the documented release from a health-care provider, they commence the gradual return to sports participation program with the student-athlete in question, Speck said.

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Welliver said that there is pressure to return a student-athlete to a sport before the end of the season. Some coaches want the Return to Play protocol to last a maximum of five days rather than a minimum of five days, he said.

Doctors have been known to sign the first form indicating there was no concussion after an athlete suffers a head injury that Welliver believes to be a concussion, he said. In two such cases, Welliver said he held the students out of competition for multiple days.

If the doctor does indicate there was a concussion on the first form, they may sign the second form shortly thereafter, he said.

In addition to his decision to keep student-athletes from playing their sport after a concussion based on age, grade and the severity and number of previous concussions they have experienced, he also takes into consideration the sport or sports the athlete would return to. Their return could take longer if they play high-collision sports.

Carroll County Public Schools officials denied to comment specifically about the case because Welliver was not employed by the school system. Johnson did say that schools often switch athletic trainers and that to his knowledge, no one has been fired in this incident.

King, Winters Mill's principal, said most athletic trainers stay only a couple of years at a high school because of the stressful work hours. Every year a discussion occurs between the school system supervisor of athletics and high school principals to see if the athletic trainer at each school remains a good fit or needs to be moved to another location.

Welliver has been working with Carroll County Public School students for 23 years and has worked at many area high schools, he said. He is almost into his third generation of athletes.

"I'm not going to change my ethics," Welliver said. "I'm going to continue to assess if a person is ready to go back based on the factors [I] discussed."

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