Where Are the Helmets in the Home Run Derby?

Last night I returned home from a lovely dinner with my injury prevention colleagues to a sight that really caught me by surprise. My husband was watching the Major League Baseball (MLB) Home Run Derby. I tuned in for a moment before turning to him and asking, "Why aren't they wearing helmets?" I think we are all accustomed to seeing players in their batting helmets, so this looked strange to me- especially in contrast to the catcher, who was dressed in full protective gear. My husband informed me that helmets are not necessary because the pitches are much slower. However- I would disagree (and this is not the first time I have critiqued professional sports and their commitment to protecting players from head injuries).

First of all, concussions (which we must remember are a traumatic brain injury!) do not only occur when the ball is traveling 100 MPH. Therefore, a slower pitch does not equal safety. The catcher still wore full protective gear. The pitcher stood behind protective netting. So on some level it is acknowledged that hazards still exist at the Home Run Derby.

In addition, concussions (or more serious injuries) can happen even when you are not the batter. Therefore, helmets protect you when you are on deck, warming up, or coaching from the sidelines. Home Run Derby participants are still at risk for injury when they are not at bat. This is a lesson that many in baseball know far too well. In 2007, a minor league first base coach was killed when he was hit in the head with a line drive. This tragic accident resulted in a change in policy regarding required head protection for first and third base coaches.

Speaking of policy, I find it strange that their batting helmet practices vary based on the speed of the pitch. This is not an acceptable strategy in other areas of injury prevention, so why is that the strategy here? We don't tell people to only wear seatbelts if they are planning to drive faster than 40 MPH. We don't tell people to only avoid texting and driving if they are on the highway. The MLB seems to be accepting a high level of risk for their players in this context. This is especially surprising since MLB and the MLB Players Association have taken steps to prioritize safety regarding head injuries. They recently implemented a universal concussion policy (which went into effect on Opening Day 2011). The new policy dictates both how concussions are initially treated and when player/umpires are allowed to return to play. The most substantial change is the creation of a 7-day disabled list to allow players an appropriate amount of time to heal after a concussion. They are also introducing reinforced helmets that can withstand 100 MPH fastballs.

While the safety of the players is paramount, this discussion is also important because MLB players are role models. Therefore, it is important that they model acceptance and proper usage of personal protective equipment. If you looked at the stadium crowd at the Derby (and the lucky few invited to catch balls in the outfield), it was mostly kids. If the MLB and the players do not provide leadership on safety policies and equipment, it could have larger public health effects on the audiences that model their behavior (so don't get me started on the chewing tobacco issue).

Therefore, I strongly encourage MLB to review their policies regarding personal protective equipment and the grey "safe" areas they have identified, like the Home Run Derby. It appears to be a relaxed, fun event during the all-star break but in reality, they are unnecessarily putting the safety of their players at risk.

The NFL is making pretty posters- but what are they doing to change the CULTURE of playing with head injuries?

Hot off the presses! Check out the new poster produced by the NFL which now hangs in every locker room in the National Football League. This poster represents a new effort within the sport to educate and protect its players from head injuries. However, I would argue that these strategies (and the others that I will outline) will not do anything to help the problem until a culture shift begins on the player level.
I was inspired to write this blog post after reading an editorial by Michael Wilbon in the Washington Post (thanks to my husband for making me a PTI fan). Mr. Wilbon compares these posters to the Surgeon General's warning that appears on each cigarette package. I completely agree- and they will be just as ineffective. Straight education and "fear-based" messages are not capable of changing behavior.

My first concern is regarding the layout and content of the poster itself. In any good health communication piece, you want the target audience to quickly and easily understand what you are trying to say and what you hope they will do after viewing the piece (i.e., what is the "call to action?"). The NFL poster fails in multiple areas:

1. It is not quick: It took me almost 5 minutes to read it thoroughly.
2. There are too many goals/calls to action (at least three by my count): 1- Education about the facts and symptoms of concussions; 2- How/why to refer yourself; 3- How/why to refer a teammate.
3. It uses some "fear-based" messages (e.g., head injuries can cause early onset dementia).

I highly doubt that this poster was tested with the target population (NFL players)- which is always the best way to produce effective health communication materials. Perhaps the players would have pointed out the obvious oversight that the photographs on the poster are not NFL players (but instead children and those playing other sports).

The posters are being rolled out in conjunction with other prevention strategies. For example, there have been policy changes (either under consideration or already active) regarding how quickly a player can come back after a concussion, how much contact/hitting can take place in practice, etc. They are also reviewing new data regarding the safety of different types of helmets and supporting a coaches committee dedicated to the discussion of player safety.

But what about the players themselves? Are they ready to sit out games? Will they support their teammates sitting out games? From many stories heard from the fields and locker rooms- players have not yet bought into this "new system". For example:

Last November (2009), Ben Roethlisberger of the Pittsburgh Steelers sustained yet another concussion. It was ultimately decided (by his physicians) that he could not play in a key game versus the Baltimore Ravens. The result- he did not receive support from his teammates. Hines Ward told the media that support in the locker room was "50-50" regarding if Ben should play. He talks about how other players have played (and would have played) through a concussion. He also discussed how they would lie to physicians in order to be cleared for play.

So while it is great to have committees and make posters, until the players are on board and feel supported by their teammates to put their health first (without consequence or retribution), these other measures will not truly be effective. A culture change must come first- and it must start with the players.