Preventing Traumatic Brain Injuries in Youth Sports: A Q&A with Robert Faherty

May 23, 2013, 11:08 AM

As we learn more about the long-term effects of traumatic brain injuries (TBI), the public health focus is increasingly on prevention in youth sports. A recent study funded by the Robert Wood Johnson Foundation and published in the American Journal of Public Health found that while 44 states and Washington, D.C., have enacted youth sport TBI laws, they all deal with identifying and responding to the injuries—not preventing them.

NewPublicHealth recently spoke with Robert Faherty, VP and Commissioner of the Babe Ruth League Inc., about what the baseball league in particular—and youth sports in general—are doing to improve the prevention of and response to traumatic brain injuries. The league includes about 1 million players across its Cal Ripken and Babe Ruth divisions.

>>Read more in a related Q&A with the author of the youth sports TBI law study.

NewPublicHealth: How is the Babe Ruth League working to prevent primary traumatic brain injuries in youth baseball?

Robert Faherty: One of the things that we really pride ourselves on— and, first of all, our organizations are entirely made up of volunteers, from the league administration level right down to the coach—is providing that league with the best insurance program we possibly can. Through Babe Ruth League, you have the opportunity to buy accident, or liability insurance. That's because we wanted to make sure that there would be no reason that a player wouldn’t go get checked out or a league wouldn’t send a player to a doctor or to an emergency room. We weren’t worried about the parents having insurance, we weren’t worried about somebody’s liability being in question—you can go to the doctor and have it covered.

The second part of that would be our ongoing attempt to educate and prevent injuries right down to the simplest practices. In our coaching certification and coaching education courses, which are mandated, not only are there safety issues that we include that in our score books that we provide to the teams, but it’s also the smallest things about how to run a practice. One of the most common injuries is being hit by a baseball, but it’s not the batter being hit by a baseball or a fielder being hit by a baseball—it’s an overthrow by kids warming up improperly, and not throwing all in the same direction.

Safety efforts range from the smallest point about on-deck circles and kids being safe around swinging bats, to all the equipment that we possibly can improve. Right now, Rawlings Sporting Goods is working on a youth baseball helmet that is going to push the prevention of the miles per hour on the deflection of the helmet up 30 miles per hour from the original helmet. If you’ve been following youth baseball, the bats have been an ongoing issue for the last nine or ten years where lawsuits and legislation and manufacturing standards have changed considerably to the point where the bat is deader than it’s ever been. But they’re trying to make bats more like wood. Although, you have the last two pitchers in the big leagues who were hit in the head were with a wood bat. So, again, you’ve got to take into consideration age, ability, and skill level, but at the same time, equipment plays into that.

The new thing that’s being studied is the pitcher’s helmet, a device that a pitcher would wear. There are studies and people are trying to figure out what’s the best equipment for a pitcher to wear while he’s pitching in the game of baseball.

We also follow all of the other larger conglomerate groups like the National Council on Youth Sports. Pop Warner Football is located here in Langhorne, Pennsylvania. We’re close to them and realize that they’re doing conferences on this same issue and we’re studying and following what they’re doing in terms of looking at best practices. Hockey is involved in that and football and other places where the traumatic head injuries become even more prevalent than baseball.

We realize we’re in an accident-prone business, and as all our best practices and as much as we want to do, when it happens, it’s just so disappointing. I would love to say to you if you give me a magic pill to make it go away, we would, it’s just we’ve wracked our brains with these best practices with the preventative stuff and being sure that no kid goes untreated.

NPH: How about for head injuries in particular?

Faherty: Babe Ruth League also does mandate that all of our leagues follow their state and local laws as well. If you’re on a high school field, that high school has particular rules, we’re not above anyone’s laws or rules when it comes to safety—and mostly now we’re talking concussions. When a catcher is run into or a kid slides into second, he might get hit in the head with a knee. That’s pretty common. Outfielders collide, pitchers and catchers collide all the time on pop-ups. They’re not looking at each other, they run into each other.

When that happens, many laws mandate that they have the concussion test certified by a doctor or sit out the ten days or what have you. That has been one of the most difficult for us to enforce because we're not there. As much as we’d like to do, how do we take it to the next level?

But by the best of my knowledge, there’s currently not a national standard in youth sports for this prevention. There is aftermath protocol, but short of mandating that everyone wear a full helmet at all times, there's not much out there—and look at football and look at other sports that have helmet-related sports injuries, too. We are sometimes at the mercy of that local programming.

NPH: How much can you actually do as a league? At this point, do you think the league feels confident they can address these issues without state laws or did having laws help to implement safeguards faster than just through your league regulations?

Faherty: The fact that we could point to a state law and say that “this certified trainer has an obligation in her position and as a doctor must be included” because of the state law, it allowed us to say to the coach, “it’s our way or we’re going to not let the player play.” If we had simply said we think we know better, I don’t know that the outcome would be the same.

There’s definitely a part of us that says, look, when there’s a state law, it helps us to pound home our point that injury prevention and player safety is paramount. Without the law, I’m not as confident. And we’re not normally a group that only leans on state laws. In this particular case, it has been helpful to move the discussion further faster.

NPH: When I’m reading about rule changes at the minor and major league levels are how are they going to adjust to these new rules or regulations, and the answer is always, well, it’s easier if that’s what they grew up with. So, that’s really the position that you’re in—helping to set these standards and be at the forefront of making the game safer. I know in youth football, having the NFL become involved has helped increase the focus on preventing injuries. Has major league baseball provided similar assistance to youth baseball leagues?

Faherty: I think major league baseball does what they do. I don’t know that they look at amateur baseball in any one particular way. Are they worried about making next year’s baseball players? A little bit. I always argue we’re making next year’s fans.

With that said, under Dr. Bobby Brown, the former American League President and New York Yankee, we did a very large smokeless tobacco campaign, and obviously, in youth sports and amateur sports, tobacco, firearms, drugs—they’re all issues that we try not to bring to the baseball field. They’re banned, but at the same time, my argument for a lot of that is if you’re out on the baseball field for two hours, you’re not doing other things that could lead to worse health.

NPH: You were talking about changes to the equipment—the composite bat, the evolution of helmets both for batters and for pitchers. Is there any concern in youth baseball that rule changes to increase the sport’s safety for young players could also change the nature of the sport? If so, how are you addressing that?

Faherty: I honestly don’t think it will change the nature of the sport. I really don’t. I think the game is still the game. What we’re finding is that the manufacturers of those safety related products for the younger kids—there’s softer baseballs, bats, helmets, things of that nature—the manufacturers were sometimes the ones that said baseball is unsafe, you should use my product, and it was looked at with a little bit of jaded eye. But I think they’ve become much smarter. There is a heart guard product available to young kids where it actually has a foam protection over the chest and the heart area, and when you had to strap that on on top of your uniform potentially, it was a bulky thing. I don’t think that kids took it on or parents even thought that this was something that my child should have. But if you go into a local sporting goods store, you can now buy what looks like a normal T-shirt with this product sewn in, and it’s almost undetectable to the naked eye. You wear it under your uniform and it’s become a popular product.

It doesn’t change the game. The extra safety precautions and things we do—probably today the fields that kids play on are much safer than they ever were. They’re not playing in open sandlots and empty fields and on the street in the large numbers that kids were in the past. The fields are pretty well manicured, they’re taken care of, the equipment’s better. It’s reviewed on a more timely basis. So I think a lot of the safety and prevention items of that are better, and again I really don’t think the game’s any worse for it.

NPH: Do you ever see the culture of sports generally could get in the way of being able to implement realistic and valuable prevention ideas?

Faherty: The short answer is no, and the reason why I say that is the culture of youth sports is rapidly changing, and I will stick to baseball. There are now shorter rosters, mandatory play rules, continuous batting orders, all things that did not exist in the game 20 years ago. Everything is about the player having the opportunity to participate, enjoy the experience and not sit on the bench—not be singled out as not good enough, all driven by parent participation and “I want what’s best for my son, and sometimes the heck with everyone else, I’m going to get what we want.”

And I promise you, at the top of that list would be safety. If you walk into any sporting goods store or look at kids, they’re coming out with better equipment, they’re completely covered in any way, shape or form that they need to be, and that’s in all sports. So if there was a way to absolutely guarantee that you could prevent an injury, if there was that one thing that says this— short of not playing, and that’s the discussion in football—I think at the end of the day, all of the best practices still lead to it was an accident and I know how we prevent that. But I do not think it’s the culture of sports, and certainly not the culture of baseball at the youth level that would prevent that from happening.

This commentary originally appeared on the RWJF New Public Health blog.