I think Bob really hit the nail on the head. Take the history at the beginning of the season. I was struck when he was talking about that patient, one of mine, a girl who came in with a history of two superimposed concussions who had actually had four of them superimposed. When she was told she could no longer play hockey, she said, “That's okay; it's rugby season next week.” I throw that back, because that was 15 years ago. I have not heard anything that egregious in my clinic in the past five years.
The kids are aware of this injury. I think everyone is aware of this injury. In fact, from the comments earlier today, we may be a bit too aware of this injury, because we're fearing this injury and maybe fearing it more than it needs to be feared. I think kids are safer now than they've ever been because of some of the changes that have been put in place over the last couple of decades.
The concussion of our kids today is not the concussion of 20 years ago. Those were largely ignored, and you would get up, dust yourself off and use smelling salts. My word. Now, you're out of the game, you're under an observation period, and do you know what? You're a kid. This is not professional sport. We don't need you back in the game today. We're going to assess you, and we're going to watch you for the next 24 to 48 hours if we need to, and we're only going to allow you to go back in when it's absolutely safe for you to do that.
That alone makes the injury much different from what it used to be. Sometimes you get caught up in the entire field, but that is the fundamental truth. These are different injuries now than they were before, and we have to watch that we don't apply what we're finding about yesterday's concussions to today's concussions. They're being reported at rates that are up to 250 times what they were 20 years ago. We're not having more concussions; we're just reporting concussions, and they're being reported at subtler concussions than they were previously. It's crazy thinking that, at one stage, one of the definitions was that you had to be knocked unconscious before people would agree you had a concussion. That's outrageous today, so things are changing.
As for the medical record, this is a tricky one, because we do want people to go from sport to sport, so we really need almost a passport system to keep people safe. However, on the receiving end, it's the culture. If we have a culture of disclosure, everyone knows that hiding concussions is dangerous. I think that, increasingly, the message for our kids is not to hide the concussion. Declare the concussion. Get better from the concussion and play your sport.