next panel we will have ian, the other face of high school level concussions. so with that, mr. daly, you are now recognized for your five minutes. >> thank you. i would like to thank the chairman, the ranking member and the subcommittee members for inciting me to testify today regarding the national hockey league and the proactive steps it has taken to promote the safety and health of the best professional hockey players in the world. the major professional sport with no out of bounds, hockey is a physical game. at the nl level -- >> is your mic on? >> it was. i'll bring it closer. at the nll level our players want it to be physical and our fans want it to be physical but importantly all constituent groups associated with the game also want it to be safe. this objective necessarily includes promoting safe and responsible play in our game and the national hockey league working together with the national hockey league players association has gone to

elaborate lengths to do that and will continue to do so. we are pleased to have this opportunity to share with this subcommittee some of the measures enacted in this pursuit. national hockey league was the first major professional sports league to launch a comprehensive league-wide program to evaluate players after they incur head injuries. beginning in 1997 the nllpa concussion program required that all players on all clubs undergo preseason baseline neuropsychological testing. after a player diagnosed with a concussion he undergoes post-injury neuropsychological testing and pre-and post injury test results are compared to determine when the player is safe to return or returns to neurological baseline which is a relevant determination in the player's ability to safely return to play. data collected and analyzed pursuant to the nhl, nhlpa concussion program confirmed to us that neuropsychological testing results had added value

and should be taken into account along with player reported symptoms when making return to play decisions. the nhl, nhlpa concussion committee also has taken affirmative and proactive steps to issue leaguewide protocols regarding the diagnosis, management and treatment of concussion. education regarding concussions and importantly the issuance of warnings to players relating to the risks of returning to play before the recovery from a prior concussion is complete have been a core component of the nhl, nhlpa concussion program since its inception. education is provided regularly to all relevant constituencies in our league including our players, club personnel and nhl on-ice officials. in addition to enforcing existing player rules, playing rules such as charging, cross-checking, and high-sticking and more stringently penalizing dangerous contact, several new playing rules have been adopted specifically to prohibit contact

involving a player's head. our current rules specifically prohibits anybody contact with an opponent's head when the contact is otherwise avoidable and the head is the main point of contact. changes this season to adopt hybrid icing rule and modifications of rules regarding fighting have further enhanced player safety. with respect to the fighting issue in particular, while it remains a small part of the game, its role is diminishing. through 75% of the 2013-14 regular season, 68% of the games played have been completely free of fighting. the highest such percentage since 2005-2006. in addition, the number of major penalties assessed for fight something down 15% from last season and down 31% from the 2009-2010 season. in this important area it would be the league's intention to raise, discuss and negotiate any potential playing rule changes regarding fighting directly with the national hockey league players association.

ultimate enforcement of the playing rules through supplement at this discipline is in the hand of the department of player safety, the first league department of its kind in professional sports. this department monitors everyone of our 1230 regular season games, plus all of our playoff games an assessing every hit, indeed every play to insure the league's standard for safety and responsible play are being adhered to. when the department determines that the standard has been violated, supplemental discipline is assessed in the form of a suspension or a fine and the department creates a video that explains to our players and our fans why the behavior merited punishment. the cumulative effect of these efforts is has begun to change the culture of the game in a positive way as we can see on a nightly basis players avoiding dangerous plays and grat few does contact they no doubt would have engaged in a few short years ago. since the adoption after mandatory helmet rule in 1979, the nhl and together with the nhlpa continued to impose

additional regulations regarding player equipment related to player safety generally and head injuries specifically including most recently a rule adopted prior to the start of this season that mandated use of face shields by all incoming players. the effect should reduce head injuries generally and in addition to providing enhanced protection for player's ice. the nhl participated in concussion initiatives extending beyond the n4. l and participation in the international sports conferences between 2001 and 20 self. the support of legislative and state initiatives regarding concussions and league support assistance of concussion educational programs for youth an junior age hockey players. sum riding there is considerable work to be done, the national hockey league will be remain absolutely committed to promoting the safety of its players. we firmly believe it is not only the right thing to do for our players, in terms of our

business, promoting participation at youth hockey level and interest by fans and consumers of the sport at the professional level. again i thank the chairman, ranking member around subcommittee members and time to speak before you at this time. >> thank you. mr. ogrean, you are recognizes for five minutes. >> thank you, mr. chairman, ranking member schakowsky and distinguished members of the subcommittee. it's a privilege to discuss with you a top priority at usa hockey that is the safety of our participants both on and off the ice. we adapted well to changing environment the over time. we have two particular leaders we wish to thank and guide a great deal of our decision making. dr. mike stewart, head of sports medicine at mayo clinic rochester, minnesota. the dr. alan a share, in boston the chairman of our safety and protective equipment committee. that committee has been in existence at usa hockey for 40 years. it is an important group helping

to guide our board in making its decisions. we have a risk management committee which is concerned with the safety of the play are environment and the surrounding area. and in 1999 in cooperation with u.s. figure skating we began an organization called serving the american rings or star, which is essentially a trade and education organization for ice facilities focusing on a variety of operational aspects including safety issues in rinks. in terms of safety of our participants we believe we can and do postively affect the landscape through three primary areas:education, risk management and. education happens on ongoing basis at usa hockey. we use many avenues to communicate. we have very fortunately direct electronic communication with every single home, every player, every pape, every official and every coach in our organization. there through our database. we're constantly educating them

through bulletins and news. our coaches have a huge influence providing a safe and responsible environment and our coaching education program has long been heralded in the amateur sports world as the gold standard for coaching education. as congressman terry referenced, this last year, excuse me, two seasons ago, we added an online educational module that is age-specific in nature which also contains critical safety information including concussion education. officials obviously play a very important part in how our game is made safe as well and they receive regular evaluation and education electronically and are sent video clips and access to our national reporting system which tracks penalties to help us understand and assess behavior trends. we annually mail posters to every ice facility in the country to help deliver our messaging and over the years those posters focused on topics including conclusion prevention, concussion education, playing

rules emphasis and heads-up, don't duck program to name a few. as for rules and rules enforce mane we have modified our rules to adapt to the evolving landscape of the game on an ongoing basis from mouth guard to helmet issues to rules aimed at eliminating dangerous behavior. another recent modification in usa hockey came in june of 2011 when our board voted to change the allowable age for body checking in games from the peewee or age 11 and 12 level up to the ban tam age group of 13 and 14. this was done despite many voices around the country in opposition to change which nobody seems to like but research based on both athlete development and safety guided our board decision. it is worth noting that two years later, hockey canada followed our lead. regarding equipment and its impact on safety, usa hockey took a significant step in 1978 when it called for the creation of the hockey equipment certification council or hec.

hec's mission is evaluate testing procedures for hockey equipment for the purpose of product certification. it is similar to noky that football uses to certify its helmets. it is completely independent body of doctors, engineers, manufacturers, testers and sports people. it validates the manufacturer's certification that the equipment they produce has been tested and meets the requirements of the most appropriate performance standards and it has been an important part of our safety story for 35 years. before closing i would like to share with you briefly our newest off-ice safety program called usa hockey safe sport. following the lead of the united states olympic committee this is to protect our participants an on policies regarding hazing, zero tolerance, locker room supervision and abuse of any kind. in the early 1990s we were one of the very first youth sports organizations to require

screening of all adults that have regular access to our youth participants. we follow up on 100% of calls we receive around the country of alleged abuse and our 34 affiliate associations each have a volunteer safe sport coordinator helps us as boots on the ground to provide the safest possible environment for our participants. our sport enjoyed tremendous growth in the last 25 years, more than doubling the number of youth players we have as we continue to provide opportunities for young people. we know in doing so, we have the responsibility to make our game as safe as possible and will only continue to grow if we're successful in doing some thank you. >> thank you. mr. miller, you are recognized for your five minutes. >> chairman terry, ranking member schakowsky, members of the subcommittee, appreciate the opportunity to testify on behalf of the national football league on a issue of great importance to the league and commend the committee for taking up this issue. there is nothing more important to the nfl than the saved of our

players. commissioner goodell repeatedly said he spends more time on the health and safety of our sport than any other issue that comes before him. football has earn ad vital place in the rhythm of american life. nearly six million kids play tackle or flag football across our country. another 1.1 million play in high school. 75,000 in college. so whether it is touch games in our backyards at thanksgiving or games played in the local parts by the kid or friday night high school games, saturdays with college and hopefully plenty of people watching nfl on sunday, mondays and occasionally thursdays football maze a significant role in our lives and we take that popularity seriously. with it comes a great deal of responsibility and one that we embrace. we understand the decisions we make affect football at all levels and probably far beyond that so i appreciate the opportunity to share the nfl's work with the subcommittee on the health and safety of our athletes that play our game.

football has always evolved. the rules have always changed. so i would like to share with the subcommittee a few examples of that over the last couple years and the impact that's had at our level. it's only been a couple of years ago that we changed the kickoff line at the nfl, moving it forward five yards. we did that because we identified the kickoff and kickoff return as single most dangerous play in our sport related to the number of concussions. so by moving it forward five yards we decreased number of concussions on that particular play by 40% that was the in first year alone. that number stayed steady in successive years. in addition for those fans you've seen greater emphasis on eliminating helmet to helmet hits in our game. you seen greater he emphasis eliminating use of crown of helmet and seen fines and suspensions and not to mention penalty as a result of that. these are the sorts ever things we're looking to do to change the culture of how our sport is played. we've encouraged player to lower the target zones as they tackle.

we emphasized through our coaching there are better ways to go about what they're doing. we've seen the results. in the past year alone between 2012 and 2013 the nfl has seen a decrease in number of concussions at our level by 13%. decrease in helmet to helmet hits causing concussions has been down 23% in one year alone. now that's not a victory. that's a trend and one we find encouraging but there is more work to be done as we begin to change the culture of the sport as it relates to that. we've added other protocols to our sideline to take care of our players. there is one rule that governs us. that is that medical concerns will always trump competitive ones. so we've added unaffiliated neurotrauma consultants on the sidelines that. is a concussion expertevery city to help the team physician identify concussion and treat players. we added athletic players in skyboxes for sole purpose of watching gail and calling down to the sideline if they identify a injury concussive or otherwise

to make sure the player is attended to appropriately. we mandated sideline protocols for all 32 of our teams so everybody is working off the same playbook. those protocols are based on internationally accepted guidelines. we would expect nothing less. we know as we change the culture of our sport as it relates to health and safety we have impact far beyond. let me cite two examples for the subcommittee. one is our support for usa football. you will hear from mr. allen back in a moment. their offerings are changing the game in our parks and communities around the country literally as we speak. the popularity of these programs which i won't steal scott's thunder on have been tremendous and nfl is a proud supporter of usa football and will continue to be all they do to change the game. we're proud of his work particularly. in addition the nfl used as, used as inspiration, a young child name zachary who was a 30-year-old youth football player in washington state several years ago who suffered

catastrophic injuries from his sport. he was returned to play too soon after suffering a concussion and zachary struggles still with the challenges that come after that. his advocates were able to pass a youth concussion law in washington state which our commissioner said we will replicate in all 50 states around this country to make sure all youth sports, not just football are played for safely. that kid and their coaches are aware of risks of concussion. that they're removed from play, should appear they suffer concussion and not return until a medical professional cleared them. just this past month, we're proud to say that the 50th state passed that law. now the nfl is not solely responsible for that work but we're happy to lead and be in many states to get this done. as my time expires little me mention two other quick components. we are proud to work with the cdc promoting concussion materials gone out to millions of kids in lockers rooms. we provided money for the heads up program. we invested tens of milliondoors

research. $30 million for the nih which is largest grant the m 236789 l has ever given. first $10 million has gone out to study traumatic encephalopathy. we have university with general electric and under armour to improve diagnosis and prognosis tis of concussion developing better tools. these are ongoing issues an ones that we think will yield significant successes in a short time. so i apologize for exceeding my limit, mr. chairman but i appreciate the time. >> at this time, mr. hallenbach. you're recognized to for your five minutes. >> chairman terry and members of the committee. thanks for invitation to testify. usa football directs programs and resources with important standards rooted in education for youth and high school football. we have experts and medicine and child advocate who believe education changes behavior for the better. this is precisely we're seeing

through the heads up football program which is benefiting more than 25% of youth football leagues in the country in the first 14 months and we expect to double that this year. we advance safety through evidence-based studies by independent experts. we lead fun and dynamic instructional football initiatives for young players as well as a national non-contact flag football program. more on these and other arrest specs of work reside in my written testimony. remainder of my time show how heads up football high school pilot program improving safety been the fairfax county public school system which earned high marks from parents, coaches administrators in the first season. pay close attention to hearing from the athletic directors and principals and superintendent of schools how this program is making a difference. >> eyes up. head up. ♪ >> when coaches to get to the

high school level i think they assume that everybody who plays knows how to play and they will be under "friday night lights" and it will be great and like it is on tv. it is not like that. you will get kids that never played before and get coaches that never coached before. you need to be able to teach coaches how to coach. >> through the heads up program, what you do three pillars as they say, one. concussion awareness. two, how to truly, properly fit equipment. finally, here's how we're teaching the ultimate aspect of contact in tackling. >> this is the basics and fundamentals. the more i thought about it and more i thought as educator this was curriculum for football. >> squeeze. see and up. >> it was really a no-brainer to get involved with usa football and the heads up program. you go through progression of tackling. they're learning how to keep their head up. not to lead with the helmet.

they're taught that from the beginning. >> it has limited the amount of concussions we've had this year basically because we have worked on heads up tackling from day one. >> squeeze. thick hands. right foot. run through. squeeze, feet. blows, there you go. head up. >> feet, feet. >> eyes up. head up. >> the coaches have completely bought in and endorsed what we're doing. >> elbows tight and high. >> what we really didn't anticipate how aggressive that the coaches association here in virginia went after it. saw the need to make the game better and safer and they ran with it. >> heads and eyes up. heads and eyes up. >> days of popping ammonia assaults and tabs are gone. that's a good thing. >> heads up football allowed concussions to become a topic of conversation in a positive way. >> i just think it standardized everything. it becomes a much more consistent way of teaching the

game. this kind of instruction keeps my staff in line. >> we're seeing a very distinct improvement and reduction in injuries and i think that says a lot about the program. >> what this has really done because we're hand on with the parents now, we're showing them on how the progress goes. we're teaching them terminology as well. it brings a level of comfort to them. >> i think it's really good all the coaches are learning proper techniques how to teach these kids to do it right. >> i'm so relieved that they're teaching these kids at such a young age because i was never taught that. >> in our family room, briton will demonstrate on his dad, not his mom, the techniques that he is learning. >> his coaches not only employ the techniques, they keep after the kids to make sure they're doing things correctly and it shows me that they really care about the kid. >> i'm not wore which worried -- worried whether he will get hurt on the field because i know his safety is just as important to them as it is to me. >> our partnership with usa football is frankly a vital

piece not only of our football program but of our athletic program in fairfax county. >> hit position. rip and shoot. good! >> it opened the door now with the lacrosse programs are talking field hockey, everybody is talking what are we doing to do overall in a very positive light? >> we agree with the mission of usa football and that is to allow our students to participate in competitive athletics and learn so many wonderful life skills from their experience but do it in a way that is healthy. >> so i can truly look at a parent who has the questions, and say, here is what we've done. here is what head's up football brought to fairfax county public schools and what we brought to heads up football. >> it is awesome opportunity for coaches parents, officials for everybody to get on the same page to help kids. >> if you're an administrator at a high school you're being ask the question, how are you making our program safeer? what are you doing for my kid? we can answer that now. ♪

>> thank you. now, briana scurry, a appreciate you being here. and you are recognized for five minutes. >> thank you very much. yes my name is briana scurry and i'm 42 years old. i served as a starting goal keep forethe united states women's national soccer team from the years 1994 to 2008. during that time, i helped lead the team in winning two olympic gold medals in 1996 atlanta games and 2004 athens and played 173 international games over 15 years for the united states. which is a record among female goalkeepers. in the summer of 1999 my 20 amazing teammates and i captured the hearts of america by beating china a penalty kick shootout live in front of 90,000 screaming fans at the rose bowl in pasadena, california. i was the one that made the

single save during the penalty kicks before brandi chastain took off her shirt. yes, now, i bet many of you recall exactly where you were at that moment. it was the kind of event that transformed lives forever. for the better. my passion and my mission was soccer. my ultimate reward was living my dreams and inspiring the dreams of countless others. today i'm here before you to share my new mission with you. my new mission is to provide a new face and voice to those who had and may suffer the long and difficult recovery of a devastating traumatic brain injury concussion. my life story reads like a script from oprah winfrey's, where are they now? like many of oprah's guests i too have been locked in deep dark places with my face in the dirt, and have only recently begun to claw my way back to my

life. on april 25th, 2010, my life changed forever. during that day i played a women's professional game against the "philadelphia independents" in philadelphia and in that game i suffered a traumatic brain injury that abruptly ended my beloved soccer career. that was nearly four years ago. i struggled with intense, piercing headaches that were so bad bit evening, it was all i coo do not to cry myself asleep. i had to take naps on daily basis because my sleep was so disrupted. i couldn't concentrate and i was very moody. i felt completely disconnected from everything and everyone. i was anxious and depressed. every day and i wondered if i would ever get better. i recently moved to d.c. to have

bilateral okay sent tall nerve surgery at georgetown to eliminate severe headaches that playing me daily. fortunately for me the surgery appears to have worked, however, i'm still being treated for symptoms such as lack of concentration, balance issues, memory loss, anxiety and depression. i purposely and intentionally had my concussion recovery story documented by media outlets such as the "usa today," "the washington post," and brianlynn.org in order to bring attention and to a ray of hope suffering from t by like me. in september i was alarmed to learn that the number of reported cases of concussion in soccer was second highest in the united states. with only american football having more cases. additionally, a recent article published in november stated that one of two female youth

soccer players will suffer a concussion while playing. i feel the numbers of reported cases are likely understated, and didn't designate those who suffered multiple concussions like i have. statistics like these have solidified my urgency of purpose, to shed light on the high frequency of concussions in youth, and devastating emotional toll that prolonged symptoms often cause, yet are too frequently dismissed. i sincerely hope ha my presence here today will inspire increased awareness, thatting, and assistance to help the thousands of young tbi suffers a-- sufferers across this country. i thank you all for allowing me to give testimony. i'm grateful and humbled to have been invited to do so.

thank you. >> thank you very much. and that was powerful. so, as this is our opportunity now. each of us have five minutes to ask you questions. so miss scurry, let me ask you this one. i too was shocked to learn that soccer had the second-most concussions which is a really dominant youth sport. are you seeing changes within soccer and unlike there is obvious top to bottom connection we heard from the nhl and the nfl, is anything like that occurring in socker is? -- soccer? >> thank you for the question. i too was very surprised to read that statistic. i think it is so high in part because of the explosion of players playing soccer now in the last 10 years. i'm not finding that soccer has

completely grasped the alarm or the situation like usa football, usa hockey have. part of the reason i'm here today is to shed light that soccer too should be instrumental in different protocol like nhl and the nfl are and hopefully the governing body for soccer which is u.s. soccer will understand our great sport is in danger of having too many head injuries and something does need to be done by the and something need to be instrumented. >> thank you. i think your assessment of the game that you played and winning that championship over china, we all, at least i remember that one event. >> thank you. >> it was a great game. now, to mr. miller, and, the nfl has taken, i think, seriously

undertaken an effort to get the so-called return to play guidelines adopted at all state levels. can you tell us more about what the guidelines are and how they're developed. >> sure. and thank you for the question. the zachary law which was the model law that was passed out in washington state contained three primary elements. the first of which would be that parents and their kid would have to sign off an education sheet, notification about the risks, signs and symptoms related to concussion before they were allowed to participate. . .

>> in the years after the raw was passed, they didn't see a single brain injury, in other words, a blood on the brain of any single football player in the state of washington. and they had normally seen three or four significant brain injuries on an annual basis, and those were eliminated. that's anecdotal, and more work needs to be done. i commend states that are making their laws more strict because they need to be expanded to the youth level. many of them are high school only. it's not just school-based sports, and there's more that can be done, and there are those that are doing that, and we're happy to work with those. >> thank you. mr. ogrean, have you seen a demonstrable reduction in concussion incidents at usa

hockey? after implementing new technique s? >> [inaudible] excuse me. we don't have the same statistical data that i think usa football has invested in and, in fact, we're talking to the same company to do that sort of thing. we have, any concussions are too many concussions. what we have focused on is research, education, rules enforcement. the statement was made in someone's opening remarks regarding the culture of certain sports and, obviously, we know that a lot of sports at the youth level suffer from a misplaced, you know, macho attitude. a lot of coaches think they are coaching at the professional level, and they are not. and so changing that culture is very, very important. we've been very, very strict about return to play rules, and

as scott used a phrase earlier this morning that i appreciate very much, and we adopt the same thing. when in doubt, sit them out. and i think when you're talking about a grass roots sport, in our case we've got 350,000 youth players in 2500 programses, and that equates to about 25,000 teams. one off our big challenges can quality control. you can't get everybody to act or think the same way. but we do know, i think, because of our emphasis on preventing head injuries and what to do with them, how to treat them, how to respond to them and making sure the return to play decision is a medical decision not a coach's decision, that the number is dropping. >> great. my time is over, and so the ranking member, you are recognized for five minutes. >> my granddaughter has played ayso soccer since she, the first time that she could, now she's on a traveling team in high school. she's 16, so i'm very concerned

about what you're saying. and even more concerned now after you're saying that soccer actually seems to lag behind other sports, and there's also been studies that have compared the rates of reported concussions for male and female athletes that tend to show that female athletes actually have a higher rate of reported concussions than male athletes in the same sports. so what would you say that we need to do immediately? i mean, i'm not -- i really do worry about her now and what could happen. so what would your advice be to female athletes, female soccer players and to those who coach and treat them? >> i, too, find that statistic very alarming. i think one of the things that needs to occur with soccer is

officials and referees, coaches need to take their heads out of the sand a little bit and realize that this is something that is plaguing our sport as well. and the video that was played by mr. hallenbeck earlier was a fantastic example of where to start. you start with the coaches. you teach the coaches the proper way to teach the players how to head and do certain drills to make sure the coaches know how to teach it instead of just letting players run around out there and let the ball head them, instead teach them how to the head the ball. and also improve the strength of the neck muscles for females that seems to be part of the issue is they're not as strong as the male counterparts in heading. and so that needs to occur. and there just needs to be an understanding and an education of what you're looking for when a head injury does occur. >> let me ask you a question, i don't know if soccer's the only sport where you quite deliberately use the head.

is that, is that an inherent problem? >> i don't necessarily think it's an inherent problem but, obviously, i think that scenario when there's a ball in the air, you're going to head, there's something highly probable that could happen. but i think if you teach it properly, you're going to have those head injuries no matter what you do. just like i said, when you play the sport, you're going to have injuries that. but i think certain things that happen during a heading situation isn't the only reason or only time when concussions occur. mine in particular happened when i was playing in the goal going for a lowball. from my left, the player hit me in the side of the head with her knee, and that has nothing to do with heading at all. head to knee, head to fat foot, head to -- head to foot, head to post isn't part of that. >> well, i'd love to get your advice as we move forward and anything that i can do outside of this body because i certainly worry about my granddaughter.

i want to, mr. miller, i wanted to ask you a question. retired nfl players face some of the most serious health challenges of any sport, yet benefits for former players are not on a par with major league baseball or the national basketball association despite the fact that the nfl has more than $9 billion in annual revenue. so yes or no, does the nfl yet provide lifetime health insurance for former players who did not play under the current collective bargaining agreement? >> no. the players are able to continue their medical coverage when they leave the game, but they're not provided lifetime medical coverage. in the most recent collective bargaining agreement with our players' association, there were in excess of $600 million that went to the players who played pre-1993 in added pensions and benefits.

all of our programs are collectively bargained with our players' association, and so i think during each iteration of our collective bargaining agreements, you've seen changes and improvements made, excuse me, to the programs for retired players including this year, for example. this past year, for example. a neurocognitive program, screening program -- >> i understand. but professional baseball and professional basketball do provide lifetime health insurance for former players, and while i understand the nfl's ada plan, what could be the reason to not provide lifetime health insurance for former players? >> like i mentioned, all of our programs, all of our benefits and all the policies are collectively bargained with the players' association, so the improvements that we've seen as far as care for retired players whether it be the '88 plan, neurocognitive benefits which help players' joint and help replacements, all of those sorts of things are made available to players should they suffer from those issues.

in addition to a number of other practices and programs including help lines and our player care foundation, the players association has additional programs to help players who are in need at little or no, -- no cost, and those programs exist today. >> i yield back. >> mr.-- [inaudible] you are recognized for five minutes. >> thank you very much, mr. chairman. mr. miller, the changes that a you've made in recent years, the rules change, the increased penalties, suspensions for rule violations, reducing full-contact practice days, can you share with the committee data that you have that this, i hope, has had a positive impact on concussions, incidents that might encourage leaders at other levels of football? >> absolutely. the, and we're happy to share with the committee, you know, some greater information than i can offer in my oral testimony. >> certainly. >> but the most interesting number from my perspective is when you count up the number, all of the concussions that were

diagnosed in games and practices preseason and preseason practices and postseason. and postseason practices. you see a 13%decrease year-over-year. >> 13% each year? >> 13% between 2012 and '13. >> very good. >> and the emphasis has been on eliminating the use of the head in the game, specifically, helmet-to-helmet hits which are a significant cause of the injury. and in those circumstances that we've been able to identify where two helmets collide, we've seen a decrease in the number of concussions by that cause by 23% in the past year. there's a lot more work to be done, and those numbers could change year-over-year, and i don't think anybody should rely upon one-year data as some sort of conclusion, but i'm happy to go further with the committee if you'd like to see more information. >> thank you, i think we would, and this is, of course, very helpful, and i hope the improvements continue. mr. hallenbeck, i believe your testimony indicated that 15 high schools in 10 districts participate in your pilot

program last year and that you are anticipating 500-1,000 will participate fall. in and, of course, i would imagine high school football is the football that most of us are experienced either through ourselves or through a child, in my case a son, and this is part of the american tradition. what are your plans for getting more school football programs at the high school level to participate, and what does your outreach entail and how do schools across the country learn about your program? i think the purpose of this hearing is multifaceted, and one of the purposes i would hope is to inform high schools across the country about your program as the video indicated occurs here next door in northern virginia. >> thank you. so, first of all, one of the common themes we're hearing, of

course, is inconsistency. and football probably is the most fragmented of all youth sports, and even at the high school level there are significant challenges there. so what we're trying to strive for is consistent teaching, consistent teaching of technique, consistent teaching of terminology and now getting out to these staunchly independent youth programs as well as now high school programs. the good news is they're actually being responsive. they're, if it's their superintendents, if it's principals, athletic directors, they're being asked as was mentioned inside video, what are you doing about this? >> and you're doing the ask or the parents and pta are doing the asking? >> it's a combination. we're talking to associations, coaches' associations, directly to coaches, we're working with athletic directors, we're working with parent groups, national pta's involved. we are looking at every conceivable channel to communicate this program and the importance of changing behavior. and what i'm sharing is there's been a very positive response. that video by itself, and really the reason i decided to show it,

has been incredibly influential. in addition, we now have the big ten, the pac-12, the big 12, the acc, we'll eventually have the ncaa, we'll have all college conferences involved, every one of their coaches will be involved with psas and thicks of that nature -- things of that nature that help influence high school coaches and high school programs to embrace the heads up football program and help change behavior. >> thank you. let me say that if there is one message i wish to leave this morning in my five minutes of questioning is that i would hope that all of those involved at your level of football would examine what you are suggesting, because after all, that touches virtually all of the american people. and i commend the panel for its testimony. thank you, mr. chairman. >> thank you, mr. lance. and i'd just editorialize, that's why we have nhl youth hockey, nfl youth football, is

because it does seem that it trickles down. whatever's said at the top, then it gets pushed down to the youth. and so that's, that was by design. the gentleman from utah is now recognized for your five minutes. >> well, thank you, mr. terry. i first want to echo something that mr. waxman said in his opening statement. it may sound obvious, but i think it's important we acknowledge this is a complicated issue. there's a lot of complexities to this, there's a lot we don't know about brain science, and i think we all could agree that the notion that this is a issue that merits significant investment and research is really something -- and it's beyond even concussions in sports. we've got traumatic brain injury in terms of our soldiers in the field. this is a really important issue that is complicated, and we ought to make sure we approach it in a thoughtful and comprehensive way. so, mr. chairman, thank you for scheduling this hearing today. i was going to ask mr. miller

without taking too long because this is an open-ended question, but could you kind of walk us through the steps as information and research has brought more knowledge to the nfl, how's the league responded, and how have you positioned yourself on these issues to address the issues of concussions? just if you could walk us through some of the history of how it's evolved within your organization. >> happy to do it, and thank you for the question. i think the point that you made that the science has evolved on neurological issues, certainly neurogeneraltive disease is one where the second panel where there's an expert lineup can talk to, but we rely on the outside advice or of very well, very well respected neuroscientists to advise us and how best to go about changing our game to reflect that. and so that's how we ended up adding, creating a unified concussion protocol and return

to play protocol for our sideline. that's how we ended up with additional concussion experts on the sideline. this is based on the advice of outsiders who tell us this is the best way to handle your players, to treat the game x if you want a culture of safety, this is what you do, and we follow their advice strictly and meet with them frequently. >> and i notice your title is senior vice president of the health can and safety policy. is that position -- that's got to be a position that didn't exist 20 years ago. >> it did not. and i'm proud to be in that role, and it's an exciting one. >> i know this hearing's on concussions, but since you're hear, i've got to -- here, i've got to ask you about a different topic. i've communicated with the nfl about the issue of human growth testing, and there's an agreement to agree later, but that hasn't always come together as much. and i know this is something that's important to the league. can you give us an update on what's going on on testing for human growth hormone?

>> sure, we appreciate the question. unfortunately, we don't have human growth hormone testing yet. the league has been ready, willing, able to pursue it since it was agreed upon in the collective bargaining agreement. unfortunately, our players' association has thrown up obstacles, probably fair to say from our perspective excuses for a period of time. and i think the testing goes to the integrity of the game, certainly, it also goes to the health and safety of the sport. >> yeah. >> you don't know where the stuff is coming from, who's giving it to a player or players, you don't know what they're putting in their bodies, and that's dangerous, and it's also the wrong example to set. this is an important issue for us and one that we're sorry has not gotten accomplished yet. >> that's an important issue to me, and that's why i wanted to raise it. i know it's not the topic of the hearing, mr. chairman, but since he was here -- >> no, but if the gentleman would yield -- >> yeah, i'll yield. >> i think that's why we wanted to have the players' association here, too, because, you know, that was a pretty strong criticism that you just made. it would be nice to have had the players as well to respond.

>> well, i'll have to now interject. they were asked, and they declined. >> yesterday. >> no. >> well, anyway -- >> that's not accurate. >> they were contacted before yesterday. >> i want to reclaim my time -- >> they still requested it. >> i've got one more question for you. where are these things going? i know when you try to crystal ball it's dangerous because you never now, but where do you things going over the next 5, 10, 20 years in terms of where technology's going to take us? do you have some things looking out on the horizon that we can be looking forward to? >> yeah. i'll give you a specific example. as part of the scientific research that we entered into with ge, the world's leader in diagnostics, we set aside what we call innovation challenges, two $10 million pots of money. the first on how to better diagnose concussions. there aren't any objective tests now, they're all subjective analyses. and we had people from 27 different countries around the world offer ideas. we've actually rewarded 16 of

them so far, biomarkers, blood tests, these sorts of things. then in addition the we just completed another challenge that goes around protective ideas, how to protect the brain better with. we had more than 40,000 people from 110 countries around the world visit the web site, people from 19 different countries offer ideas and protective equipment, and we're reviewing those now. i think because there's a lot more attention paid to this and, hopefully, we're one of the actors that are catalyzing the science that you're going to see changes in all of these places rell tvly soon. -- relatively soon. >> appreciate that. mr. chairman, my time's up, so i'll yield back. >> thank you. the gentleman from kentucky is now recognized for five minutes. >> thank you, mr. chairman. thank you for being here. that, quite honestly, might have been the only soccer game i've ever watched from top to finish. [laughter] >> thanks a lot. >> my daughter was interested -- >> no pun intended with the top. [laughter] >> okay, no pun intended. [laughter] that went over my head, i'm sorry.

but it was, what a great sporting event, and it's one of the great moments and to be part of that and something special, and i think it was special because just so much american. it was youthful, you were underdogs, you were grit, determined, brandy chastain saying not i, maybe a little exuberance, but it was a great moment, and i appreciate you sharing. i played high school football, that's my claim to athletic prowess, i guess, which wasn't. but we practiced in august, i remember one time in the south 90-something degrees and we're all running, water break, and some smart aleck kicks another guy's foot, knocks the water over. so the coach says we're just not going to have water today. that was over 0 years ago -- 30 years ago. and that would never happen anywhere today. there was actually, in louisville, a young man who passed away on a football field, and the coach went to trial over it.

and turned out he wasn't convicted, but -- so i think the awareness and, you know, stuff like what i described in my youth would never happen on a football field anywhere today, at least i hope it wouldn't. but we still have these injuries, and i think you talked about your injury being, it wasn't heading, it wasn't changing tactics, it was just in soccer you're wearing cleats and short pants and a shirt. and somebody hit you in the side of the head with their knee. >> right. >> and when you look at -- i watch a lot of football. of course, they have targeting. if you're in college football, you're ejected from the game for targeting. but a lot of the injuries you'll see is the quarterback gets knocked down and somebody runs, and their knee hits them on the side of the head. and i don't know how you change, how you deal with that kind of -- i know you're trying to do the techniques and not heading the ball in the right way, but just the incidental things that because you're playing a sport that, or going 100 miles an hour. do you have any comments on that? >> yes.

well, thanks for the question. that is very relevant, actually, because my hit when watched it, actually, last night again on video, it doesn't seem to be a hit that would have taken me out of the game. as it was, i got hit, and then this was a few minutes later before i ended up actually coming out. there really, this wasn't even a foul called, actually. so that's part of the problem, right? sometimes a hit is a glancing blow, and it doesn't even really seem to be anything of a big deal. but i think for me my main focus is what is done after a hit occurs. and to keep children and young players off the pitch after a blow occurs to assess them and then determine whether they're ready to go return to play or not. i think that is the key for me and why i'm speaking out about this, because i've been around the country talking to different

organizations, and i'm finding that kids are getting concussions five, six, seven in a very short period of time because they're returning to play too soon, and that's where i think a lot of the awareness and education can help. >> thank you. and, mr. miller, i mean, like -- and you should do everything you can to stop the head to head and so forth, but it seems, because they'll play them on tv when somebody getted injured and they're out, someone like john runyon hits the side of somebody else's head. it's just incidental, but i guess you're right. you can't really prevent that from happening, but it's how you react? >> i think that's right. one of the recommendations made by the fourth international concussion conference in zurich was to look at the playing rules of the game. and in our case we've done that, and i know other sports have done that as well so you create the best possible situation. in a contact sport, there will be injuries, and there will be,

you know, hits to the head, and those problems occur. and so where that happens we want to make sure we're treating them appropriately, so that's where the focus shifts, from prevention to appropriate treatment. >> are i just want to say, i was sitting on the edge of the couch leaning and moving as they were shooting against you, and hopefully you felt my assistance and were able to help us both together win one for our team, right? is. [laughter] >> absolutely. >> thank you very much. i yield back, mr. chairman. very good job. i'm glad to meet you. >> thank you. >> thank you, mr. guthrie. the gentleman from maryland is recognized for five minutes. >> thank you, mr. chairman, and thanks for the hearing and thanks to our panel. mr. hallenbeck, i had a quick question about whether the school districts that you've been working with that have been implementing this, has that affected the, like, liability policies that they maintain as a jurisdiction?

in other words, is there any trend towards they may be getting pushed by the insurance industry, for example? so in other words, insurer would say, well, previously i would have provided liability coverage to your school district based on these measures or assurances that the district made with respect to how it's conducting its sports program, but now that there's this program that enhances the safety of students and young people, we want to see that you've implemented that in your, in your district or else we're not going to provide the policy coverage, or we're going to charge you a higher premium? i mean, you can look at it the other way, you get a discount off of your premium as a school

district because you've implemented these kinds of measures. and i ask that because i think that increased awareness of some of the risks from these sports injuries may lead to pressure in terms of liability on school districts. and you'll get some that may choose based on the premium that gets charged to push the program out because they don't want the liability that comes with it. so i was just curious whether your program has, whether you're aa ware of that -- aware of that kind of effect from the program or more generally aware of kind of how the liability concerns intersect with some of these safety efforts that are underway. >> so thank you for the question. at the high school level, we're literally on the front, you know, 1-yard line marching down

the field. and i will mention that we're having very positive conversations with the state of maryland right now about participating in heads up football across entire state. but, so we have a lot to do there. we have not seen anything from a liability concern, insurance concern with fairfax county, worked very closely with all their schools and their school district about those issues, but they told us and we checked ourselves, they felt they had the appropriate coverage. however, to your point, at the youth level we are absolutely seeing the insurance industry at large and really the largest provider of casualty and liability insurance step forward and actually stated that that if youth football league's participation, the heads up football program, they would receive a discounted program and a more comprehensive coverage. so we're absolutely seeing a positive response by the insurance industry which, of course, has its merits. >> thank you. i yield back. >> mr. ogrean, do you have -- is

there insurance liability issues at usa hockey? >> [inaudible] yes, mr. chairman, there are plenty of insurance liabilities. and i think unlike usa football, for example, which is much more decentralized than are we, our participants are all insured by us as a national organization. so whether it's player accident insurance or whether it's catastrophic insurance, whether it's liability and even dno for all of our leagues, all of that is part of what our members pay us a membership fee for. those claims or those premiums are obviously based upon the number of claims. and so that's another business reason why it's in all of our best interests to try to come up with ever technique, every practice, every policy that we possibly can to make our game safer. the number one reason, of course, is the safety of the human beings playing our sport. but there's good business reasons for all of us to the want to do everything possible

to make the game safer. >> thank you. mr. kinzinger, you are recognized for five minutes. >> thank you, mr. chairman. thank you for your leadership in holding this hearing and to all of you, thank you for being here and bearing through a bunch of politicians. i appreciate it. i appreciate the diverse panel that's gathered here and the important insights you guys were able to provide on the prevalence of concussions in sports. according to the cdc, 175,000 sport-related concussions impact youth athletes each year, and i think today's hearing has been very constructive on helping us to understand that and alleviate that. i read much about the legislative action taken across the united states to pass concussion laws. in my home state of illinois, similar legislation was passed in 2011 to require that education boards throughout the state work with the i'll high school association to adopt guidelines that raise awareness of concussion symptoms and insure students receive proper treatment before returning to the team. in addition, it's encouraging that professional sports leagues and teams are taking steps to

address concussions not only in their own ranks, but also working with colleges and youth leagues to bring attention to the issue. last year the chicago bears, go bears, kicked off a pilot program to provide certified athletic trainers at three high school stadiums during chicago public school football games. such high profile initiatives are important to come watting this issue -- combating this issue, and i applaud the chicago bears for their leadership. again, i find these steps promising, but we're still confronted with staggering numbers of youth confronted with concussions. maybe i won't take all five minutes, maybe i will. let's talk about the equipment issue in terms of i'll ask each of you to respond. where are we at today in terms of what kind of equipment is being utilized to protect versus where we were a few years ago, what kind of advances are yet to be made that you think we're on the cusp of making or that we should make, and then is this backed by medical science? is that going into this idea?

so, mr. daly, i'll start with you, and i guess whatever you want to put into that subject would be great. >> well, thank you for the question. it's a very important issue, obviously. so the equipment issue is a very important issue and something we're focused on jointly with our players' association. we have a protective equipment subcommittee that's part of our joint health and safety committee. so is we look at all aspects of equipment and -- so we look at all aspects of equipment particular i -- particularly as it relates to head injuries, how we can perhaps reduce the amount of head injuries we have. we've passed some rules over time with respect to some of the equipment we had seen develop over the years with hard padding both in the shoulder area and the elbow area and those potentially causing head injures. so we've mandated padding over those, of those areas of players' equipment. the helmet issue is a difficult

issue particularly in hockey in terms of preventing con clution, and one of the things -- concussion, and one of the things we're looking to work with our manufacturers on is research in terms of dealing with the rotational forces that can cause concussions, particularly in a sport like hockey. and whether a helmet can be designed to deal with those more effectively than it currently does. >> thank you, sir. mr. ogrean? >> i think mr. daly answered the question pretty well for our sport. there's a greet deal where we rely on the national hockey league to be the leader, and a lot of what they do is of benefit to us in a trickle-down fashion. but as i mentioned in by opening testimony, we do have a safety and protective equipment committee of 40 years standing. they do look at a variety of issues. the face mask, for example, is something that is mandatory in youth hockey, it is not in the national hockey league, though the shields for incoming players are now a standard. >> i'm going to have to cut you off just because of time.

>> that'll be fine. >> football helmets were designed to prevent against skull fractures, and they do a fabulous job of that. they were not designed to protect against concussion, so that sort of technology or design, i know that the helmet manufacturers are working on it. we're not there yet. and the league is doing what it can to inspire that, to get new ideas around that. and the other thing we do is we do regular helmet testing in concert with our friends at the players' association so that we can inform our players of which helmets are working best. >> mr. hallenbeck, ms. scurry, you guys -- >> trickle-down effect, again, is important. we're working now closely with the sport and fitness industry association and their new football council, so we're getting insight from them and working together on how we can improve things. >> thanks. and ms. scurry? >> as you know, we don't wear equipment in our sport, but i do want to commend your state for their illinois youth soccer association is taking a real lead in concussion awareness.

i actually just did an event in chicago just last weekend for the association and talking about concussions. and so your organization is doing a great job. but in terms of equipment for my sport, we don't really is -- really have anything right now that is widely used but hopefully in the future there could be something to help. >> thank you. mr. chairman, i'll yield back. >> gentleman from west virginia is recognized for your five minutes. >> thank you, mr. chairman. i had to slip out for another meeting, so maybe some of these questions have been asked, but if you could help me out on this a little bit. one is, is there anything that we can learn from the defense department with concussions, injuries that we're hearing from when we talk to our troops that come back? i'm just wondering if there's some way that we're all talking to each other, if you could help out on that? mr. miller? >> yeah. i'm happy to take that question. we're very proud of the relationship that we've fostered over the past couple years with

the u.s. army in a specific memorandum of understanding that went back a couple of years that covers a variety of different things. we've gotten current and retired players together with returning, active service members to talk about cultural issues. what is it about football or what is it about the military that makes it very difficult for somebody to remove themselves from play or, certainly in the case of the military, from are a battle? we found a great deal of reticence on behalf of both populations to remove themselves from their comrades or teammates. and it instills a question how you get somebody to tell their colleague or teammate, hey, you don't look right, you should get off the field. and briefly, we meet regularly with the army to talk about the research that they're doing from a scientific perspective. we share our agenda, the ideas that we have, and they do with us as well, and it's proven to be a cooperative and beneficial relationship thus far. >> okay. the other, anyone else want to add to that about our military? the second question has to do

with states have worker's compensation programs to deal with the various disorders and injuries. from my state it's treated in a way that people don't have to take legal action to get help through the worker's comp program. is that something that would be a benefit here in this for -- in this program for injuries? we have, a friend of mine has spent quite a few years in litigation with the nfl other this matter -- over this matter and just thinks it's such a cumbersome -- and we also have a east coast hockey league team in our city, and we see some of the injuries, and we hear from some of the players and coaches about that injury. is there a time we should have a worker's comp program for brain

injuries? should that be included in something? >> um -- >> they're not required to follow litigation to get help. >> if i may, my case, actually, is worker's comp case. i've gone through worker's comp to get the different doctors to see different techniques that will help me. and that is part of my situation and part of the reason why it's taken so long. because every time something is suggested or recommended, i have to go back to an insurance company to get permission to do it, and sometimes it takes a hearing to get everything moved forward. so maybe streamlining that somehow would be of great help and also in your previous question you talked about how can we help the military service people who have tbis. for me, one of the best things i think would help is more on the psychological side and testing

depression, anxiety and pan you can attacks to -- panic attacks to make sure that each person who comes back from the military with a tbi gets help in that area, the emotional side and not just the physical. that would be very helpful, i think. >> thank you. any other thoughts? >> worker's compensation laws are really different including for us in canada where professional athletes are specifically excluded in most worker's compensation laws. but it's certainly a mechanism that an increasing number of our former athletes are using in cases where they have debilitating injuries from their playing careers. >> so would you, so what was your recommendation then? you're saying, yes? >> well, again -- >> looking at that? >> i guess what i'd say is i think it's generally available to our former athletes currently, the worker's compensation protection. >> i guess maybe i'm hearing

somewhat differently from that, that's why i want to raise it. thank for your comments on that. i yield back the balance of my time. >> gentleman yields back. mr. bilirakis from florida, you are recognized for five minutes. >> thank you very much for holding this very important hearing, and i wanted to specifically thank ms. scurry for really speaking out. i really appreciate it. makes so much of a difference, and thanks for your sacrifice. you're going to make a real difference in kids' lives. i also want to ask, i wanted to get back to the protective gear, the helmets, what have you. and how does the youth, and we can ask all of you, how does the youth helmet, the protective gear compare as far as safety, quality to the nfl and nhl? i mean, can you give me an opinion on that?

>> so certainly no expert on exactly how that compares. i mean, my understanding is there, obviously, nfl is the standard bearer and, certainly, all the hell melts have to pass that standard, and i think the manufacturer would say they go above and beyond that. how it compares to an nfl helmet, generally speaking the youth helmet is lighter, but the padding and so southern -- so forth is appropriate. i don't know the exact details. i know it's sufficient based on standards and so forth. many of the kids, though, i mean, the youth players by 10, 11, 12 years old they're transitioning into what might be considered high school or adult helmets, so they're getting the best available. and the other thing i would add is certainly i am aware that the technology is improving in helmets and shoulder pads and football equipment generally. it's definitely improvingment. >> mr. miller? >> sure. we worked on a program with the consumer product safety commission, our players association and some others

recently that we would put money towards reconditioning helmets, older helmets for youth leagues. certainly leagues that have, you know, budget constraints as many do probably don't get around to reconditioning them frequently enough. and so we put a fair amount of money into that program in coordination with the cpse and u.s. football runs an equipment grant program as well. so addressing these needs. we know that a new helmet's better than an old helmet. most important of all is that coaches learn how to fit the helmets. that's going to be the number one safety piece to the equation as it relate to kids. so we're aware of these issues and trying to make a difference there as well. >> so in your opinion, the youth helmet, the high school helmet is not as safe as the nfl, but you do have a program to help. is that correct? >> yeah. i don't know about the -- >> quality might not be as good. >> i don't know about the comparative safety of the helmet. >> okay. can i talk to you about this

particular program? >> of course. >> because i know of parents where the kids play high school football, and the parent will purchase a better quality helmet for the child. and, you know, concerned about the kids that don't have the, you know, the parents don't have the money to purchase that, and it's so very important. so i would appreciate working with you on this. >> every kid deserves the proper equipment. >> there's an existing grant program out there, i'd like to hear about it. and then also can i hear from the hockey as well? >> sure. at the youth level, i think the helmets are just as good as the national hockey league. the only difference is size. they have to be certified by the hockey equipment certification council, a three-year expiration date on every helmet. you can't use a helmet that's more than three years old. >> very good. nhl want to -- >> no, i would first echo mr. miller's comments that, you know, helmets in our sport as well are principally designed to prevent skull fractures, they're

not principally designed to prevent concussions. and sometimes they can disperse force in a way that does prevent concussion, but that's not their principal purpose. we also have regulations that we make available to our equipment managers and players with respect to frequent replacing of helmets. so each player is, essentially, asked to replace his home helmet at least once a season. and his road team helmet at least two times a season because we're worried about aging effects and degradation that accompanies travel requirements for our team. so frequent replacing of helmet is the a priority for our league as well. >> are the coaches educated? i mean, do they know which size fits the child? have they been briefed on those particular issues? because that's so very important. youth sports, hockey and football? >> they are. i agree with mr. miller that it is a, the it's a big difference

maker, you know, in the helmet doing its job, but it's a pretty fundamental part of what a coach has to do to make sure the players on his team all have the proper equipment and are wearing it in the right way. >> very good. >> and i would just add that's a cornerstone of our heads up football program, equipment fitting. >> very good. >> because, frankly, at the youth and high school level we've found they don't foe how to properly fit equipment. >> thank you very much for including that. as far as the, you know, the youth, of course the nfl, hockey stars, what have you, baseball, basketball, they're looked up to by our children, as you know. do y'all have programs that speak, maybe go to schools, football players, what have you, professional football players go to the schools and speak on these particular issues? >> yeah. one of the -- and our active players are by and large terrific at this topic. one of elements we included or offered up to usa football as

part of the heads up football program was actually what we with call an ambassador. so for leagues that were early adopters of the program, they would get visits and consultation with a retired nfl player. we're trying to encourage our clubs, with great success by the way, they've really done a terrific job of embracing in their communities the youth leagues and others so that they're around the facility more, that they interact with coaches, trainers and, certainly, players. which, obviously, the star quality of it brings anticipation to it which was part of the -- attention to it which was part of the motivation this the first place. but we have found retired players thrilled to participate and really active and helpful to the end you suggest. >> gentleman's time has expired. so if any of you want to answer that question, you'll have to do it by writing. [laughter] and brings me to the point that -- oh, you have a question. i'm sorry. recognize the gentle lady from virgin islands. >> thank you. and thank you, mr. chairman. sorry i'm late, i was at another

hearing downstairs. mr. miller, i'd like to ask you this question. many tens of thousands of helmets are used every year that are more than ten years old. i understand that the nfl participated in a program initiated by the consumer product safety commission by donating money that would go towards new helmets for youth football players in low income communities, and i really want to commend the nfl for this initiative. of course, it's going to cost a lot more money to get to the point where virtually all kids around the country who play football no longer wear old helmets that are likely degraded or obsolete. i'm pleased to know of your donation to the initiative, because it strikes me as an acknowledgment that wearing an old helmet when playing football is not advisable. a statement from the nfl, that would be very influential. we've also heard that reconditioning those under ten years old is important to insure the proper foam density and that other degraded parts of the helmet are replaced.

so i wanted to is you the follow -- the following questions for a yes or no answer. i guess that's why i'm sitting in chairman dingell's seat. [laughter] we realize that many issues are subject to negotiations, but can the nfl commit to supporting probe hinting helmets on the field that are over ten years old? >> in the youth space? you're talking specifically about youth football prohibiting helmets that are older than ten years there? you know, i plead not enough familiarity with the issue. i know there are a couple of states who have taken that step, and we'd be happy to work with you to pursue it. the prime place, as you mentioned, that we work with in promoting new or refurb bished helmets is through usa football who has a grant program as well. but -- >> so the first question is committing to supporting, prohibiting helmets on the field that are over ten years old. could you commit to supporting a

poll position that helmets over ten years old present an unacceptable safety risk? >> that's the position that's taken by most of the helmet industry. >> if that's the position of the helmet industry, i'd see no reason why we would have a concern with that. that sounds appropriate. >> riddell and adams strongly support their helmets be with discarded after ten years? could you support that policy? >> we would certainly support helmet companies and how they advise people to use their products. >> we've also heard stories of players using beat-up, lucky college helmets or adjusting the helmets by perhaps removing some padding in the helmets for comfort. will the nfl commit to support a policy position that all players should wear helmets that are reconditioned properly? >> all of our players have choices in which helmets they use as long as they pass the

certification body's standards. so that's something that's a point of discussion with our players' association, and players have to use helmets that pass the standards. >> and they were reconditioned properly and they had the appropriate padding? >> sure. the nfl players' helmets are reconditioned regularly is my understand, and our equipment managers work with the players to make sure that their helmets are in good working order. >> thank you, mr. chairman. >> [inaudible] [inaudible conversations]

>> part of our hearing today where we're dealing with neuroscience and medical research and fizz bics -- physics. well, physics when dr. gay gets, arrives. so panel two, i will introduce you from mr. cleland on down. mr. cleland is the assistant director division of advertising practices at the federal trade commission. we have ian heaten, student ambassador for the national council on youth sports safety. and if i might editorialize, i think jan did a great job of juxtaposing a face of tbi and concussions on each panel. and ian, as a high school lacrosse player, is that face for the more scientific-based panel. so thank you, ian, for taking your day away from school.

i know how tough it is to be pulled out of school and come testify before congress just like a normal high school student. [laughter] then dr. robert graham, chaired committee on sports-related concussion in youth at institutes of medicine. dennis molfese, ph.d., director center for brain, biology and behavior at the famed university of nebraska. then -- thank you, doctor. then mr., dr. james johnston, assistant professor, department of neurosurgery at the university of alabama birmingham. star of screen, dr. tim gay, ph.d., professor of awe tonic, molecular and optical physics, university of nebraska. gerald gioia, ph.d., division of chief neuroyo psychology --

neuropsychology, children's medical hospital. and not quite up to the level of university of nebraska, we have the harvard medical school. that's just humor. [laughter] professor of -- yeah. professor of psychiatry and radiology at brigham and women's hospital harvard medical school. thank you for for being here foa very impressive and esteemed panel of scientists and experts. and, mr. cleland, we will start. you are now recognized for your five minutes. >> yeah, the green light is on. is it better? thank you. i'm richard cleland, i'm assistant director for the division of advertising practices at the federal trade commission's bureau of consumer protection. i'm pleased to have this opportunity to provide

information about the actions we've taken over the past few years with respect to concussion protection claims. claims that implicate serious health concerns, especially those potentially affecting children and young adults are always a high priority at the commission. the commission strives to protect consumers using a variety of means. first and foremost, the agency enforces section fife of the federal -- five of the federal trade commission act which prohibits descent i have or unfair acts or practices. the commission has determined that a representation, omission or practice is deceptive if it's likely to mislead a consumer acting reasonably under the circumstances, and it is material that it is likely to affect the consumer's conduct or choice, decision about a particular product at issue. the commission does not test products for safety and efficacy. it does, however, require that an advertiser have a reasonable basis for all objective claims conveyed in an ad.

the commission examines specific facts of the case to determine the type of evidence that will be sufficient to support a claim. however, when the claims involve health and safety, the advertiser generally must have competent, reliable scientific evidence substantiating that claim. as awareness of the dangers of concussion has grown, sporting goods manufacturers have begun making concussion protection claims for an increasing array of products. these include football helmets and mouth guards but also include other types of products. in august 2012 the commission announced a settlement with the makers of brain pad mouth guards. the commission's complaint alleged that brain pad lacked a reasonable basis for its claim that is the mouth guards reduced the risk of concussions, particularly those caused by lower jaw impacts and falsely claimed that scientific evidence proved that mouth guards did so. the final order in that case prohibits brain pad from

representing that any mouth guard or other equipment designed to protect the brain from injury will reduce the risk of concussions unless the claim is true and substantiated by competent, reliable scientific evidence. in addition, the commission sent out warning letters to nearly 20 other manufacturers of sports equipment advising them of the brain pad settlement and warning them that they might be making deceptive concussion claims about their products. the ftc has monitored these web sites and is working with them as necessary to modify their claims on their sites. and in some cases, insure that the necessary disclosures are clear and prominent. commission staff continues to survey the marketplace for concussion reduction claims and alert advertisers who are making potentially problematic claims of our concerns and of the need for appropriate substantiation for such claims. commission staff also

investigated concussion reduction claims made by three major manufacturers of football helmets; riddell sports incorporated, schutz and zenith llc. if these matters -- in these matters, the staff determined to close these matters without taking formal action by which time all three companies had discontinued the potentially deceptive claims or had agreed to do so. those cases are discussed in greater detail in the commission's written testimony. the commission plans to continue monitoring the market for products making these claims to insure that advertisers do not mislead consumers about the products' capabilities or the science underlying them. at the same time, we are mindful of the need to tread carefully so as to avoid inadvertently chilling research or impeding the development of new technologies and products that truly provide concussion protection. the commission appreciates the committee's interest in this

very important area as well as the opportunity to discuss our agency's effort to insure that the information being provided to consumers, in particular to the parents of young athletes, the truthful and not misleading. thank you. >> thank you. now, ian, you are now recognized for your five minutes. >> chairman terry, reactioning member schakowsky and members of the subcommittee, thank you for the opportunity to share my story today to. hi name is ian heaten, and i am here as a student ambassador for the national council on youth sports safety. i am also a senior at bethesda chevy chase high school in bethesda, maryland. i was a sophomore playing in an off-season lacrosse game when i sustained a serious head injury which we later to discovered was my third concussion. until then, i did not appreciate what a great life i was living. i got good grades in challenging classes, played high school lacrosse, was working on my second-degree black belt in martial arts, had a job i loved

teaching tae kwon do, performed at my school's jazz ensemble and had an active social life. it was over in a split second. my concussion left me with only 5% of normal cognitive activity, and i was almost immobilized. i've spent two and a half years recovering, and at times have ever wondered if i would ever get that life back. it has been a long, slow process. at first, all i wanted to do was sleep. noise, light and even moving my eyes caused headaches and nausea. i was enrolled in the children's hospital score program that doctor gioia will describe later where i received treatment for symptoms. after missing school for two weeks, i tried to go back but was unable to function. the frustration of trying to focus on lectures, moving through the pandemonium of the halls and the constant sensory bombardment made a normal school day impossible. however, through my school i eventually enrolled in a home teaching program, and with the

help of my tutors and family, was able to complete my semester course work at my own pace. i finally returned to school in december but was still far from recovered. i have spent the two and a half years since my concussion slowly regaining organizational skills, the ability to learn and retain information and most important, my personally. personality. during this time, my friends and family learned to recognize the signs that meant i needed to shut down from any kind of mental or physical activity for a day or two. these relapses were particularly tough and discouraging and meant that i had to drop a class and miss a band trip to chicago among other things. the worst was when i had a crash and could not go to my first concert, the red hot chili peppers. the friend i gave my ticket to really owes me. the spring after my injury injury, i was medically cleared to return to sports but made the hard decision to not play intensive sports again. i know that a lot of people

recover and return to play, but the possibility of another concussion means i could lose everything again just like that and not come back the next time. .. i played baseball talk soccer and lacrosse and being on those teams not only gave me a healthy

outleoutlet but part of the impt lessons. sports are one of the best parts of becoming a strong adult. they teach us that we can become skilled and proud of our accomplishments. they teach us how to be part of a team to have pride and success. they teach us that sometimes we have to quit thinking about ourselves into thinking up the good of the team. for these and other reasons i hope steps can be taken so that athletes have these opportunities. there are two important things i think would make a big difference. the first is to change getting hard to take out a good opponent and brushing off injuries to get back into the game. while better equipment may decrease injuries that his coaches, parents and players that have to back away from the need to win at all costs or the fear of losing status on the team went out for an injury. to be willing to recover before

returning to play it will take a while, but if the youth and professional sports are to survive, these attitudes must be embraced. second when the injuries occur we must have a way for the qualified personnel to quickly assess injuries on the field, have the players get immediate attention and then support of recovery through schools and medical institutions. these are the things that were done for me and are the reason i've been able to return to normal. as a student ambassador for demand to become message i hope to give young athletes is you think you are in a vulnerable commute takes risks because you think you will recover quickly from anything that happens. you won't. don't be heroes especially when it comes to your head. it's the only brain you will have and personality is who you are. it's not worth a couple of seasons to lose the opportunity of a lifetime.

>> thank you very much, ranking member. my name is bob graham and i serve as the chair of the institute of medicine sports related concussions and youth studies. as you have my testimony before you and i think the copies itself i will just try to take these minutes to give you a summary. if its charte it's chartered bye congress to provide advice to the executive on the scientific issues we were specifically in the panel to look at the evidence about the causes and consequences of the kind caution and youth and military, the state of diagnosis and management, the role of protecting equipment and a sports regulation. we have 17 members on the committee and we worked in 2013. the doctor who will follow me was a member of that committee. and we came up with just six

recommendations. the first was that the cbc needed to establish a better mechanism for the national surveillance to comprehensively capture the incidence of concussions. you have heard a number of figures this morning about a concussions in one's order or another. we know what the incidence is and where they are measured. we do not know what the instance is in sports where they are not measured or they are not for closely watched. we need to have a baseline to know the degree to which we have a problem and as we take corrective measures the success rate that we are having and making an impact on decreasing the incidence of the concussion. number one we need better surveillance and better epidemiology. number two a couple of recommendations related to the research we need the nih and the

dod to look specifically at what metrics and markers are for concussions. how do you assess the severity of a concussion and find whether or not an individual has had a concussion clicks it is largely based upon observation on the self-report, but are there some physiological markers that could be used to get a better documentation and at the concussion has actually occurred perhaps without the individual knowing it or being observed. second, we need the nih and the dod to look at the longitudinal short and long-term consequences of concussions. we have heard testimony on this panel and prior panel individuals that have had one or more concussions are the long-term of the individual multiple concussions that gives a sense about not only the

epidemiology of the problem that we are dealing with, but with treatment and interventions may be and what the rehabilitation may be. fourth recommendation was to the ncaa international federation of state and high school associations to look at the age-appropriate techniques and other roles in the playing standards and again the first panel talked a little bit about that post way at the professional level, but can you change the manner in which the sport is practiced and of the rules of engagement in the sport that made decrease the risk of the kind caution there was an example from the hockey area where the they had a change to e level where they allow the body checking and felt they saw the concussion that we think that same sort of examination should take place at th the college thd vehemently high school level to see whether or not they can have the same impact. the fifth recommendation had to do with a better study of what

the role may be for the protective equipment and again, the first panel talked a lot about that. the committee had a number of questions about that. our committee found there was very little evidence that the helmets protect against concussions. there is a lot of data and i think some of the other panelists will be talking about that. you may come away with an equivalent degree in physics equivalence degree in physics this morning. it is a complicated issue. there are a number of suggestions. we certainly don't recommend that you don't use helmets. they do protect against bone injury and soft tissue injury but the suggestion of the helmet itself may decrease the incidence of concussion. the evidence doesn't appear to be there for us and we think that again they have a role in looking more specifically at what we may be able to do related to the biomechanical

determinants and protection against concussions. and then the final recommendation had to do with a topic which hathe topic which hp frequently and that is changing the culture and the way that concussions are viewed. this is a significant injury. athletes need to be encouraged to report to take themselves out of the game and coaches and parents need to be encouraged to say for your own protection you need to be removed and give your self a chance for recovery. >> thank you, you are recognized for your five minutes. >> thank you chairman and ranking member and members of the subcommittee for this opportunity. if we could have the slides. so i think the earlier group talked about a number of -- if you can put on the powerpoint a

number of sports where the rate of the concussion is particularly high and there are differences for the men and women. the doctor will talk about some of that in terms of the weaknesses of the next relative to more risk for concussions next slide. the concussion accounts for in the united states roughly 75% of the brain injuries. there is a discussion about whether it is permanent or temporary. in the military is 77%. so it turns out that they were a good model for also looking at concussion in terms of the military. and in fact most of the concussions occur in situations most like they do with the rest of america. some certainly occur in the

other but the majority of her outside of the theater and accidents we are prone to experience if we look at the brain injury overall there are estimates these are all estimates and a very across the literature looking at somewhere in the neighborhood of about 4 million brain injuries per year in the united states. part of that is that the birthratbirthrate in the uniteds roughly about 4 million. this doesn't count other ways that children are exposed to head injuries disciplining a parent who slaps a childhood creates rotational movement that can infect produced a concussion and that is largely not reported. recovery is generally click anywhere from a few hours to a few days. some persist to two weeks or out

to six weeks but 20% seem to persist beyond that time. next slide please. this is on sunday that we have under review but this will give you some sense of this is recorded using bringing the electrical activity so basically, you have the net of 256 electrodes that fits on the head in about ten seconds or so. and we present a series in this case one number at a time. of the college athletes had to do was simply say the number we currently see matches or does not match the number that occurred to the physicians earlier. and on the left side of the orbits, the circles that you see with the colored circles on the left for the matching and the nonmatching popular images of the brain electrical activity on the scalp recorded from those electrodes between 204 milliseconds so two tenths to

for four tenths of a second after the number of peers. so, the schematic on the right shows you the position. so it is a very rapid response. for those that have no history of the concussion we see a difference in the electrical activity for the match versus the mismatch a lot of yellow and green on the top left and on the bottom we see fred and blue. on the right these are individuals that have a concussion of one to two years earlier and a 204 milliseconds they cannot discriminate whether those numbers are the same or different. they ultimately get the tasks correct that takes 200 milliseconds longer. the processing is slow and after two years one might suspect that is a permanent change.

the next slide? in terms of critical scientific gaps some of these deal with what doctor graham talked about how does the concussion effect the brain and the short end of the long-term we don't have much information about that. what is that for the requirement to continue to produce a concussions and i'm how can we object when the brain is injured and when it is covered there are lots of differences from one person to the next i think there are genetic factors involved that there could also be a concussion history. the person may not think they have. how many of us have bumped or had getting in and out of the car so we have a quick rotational movement that could perhaps produce a concussion. and then how does the brain recover?

and finally how can we improve and recover and accelerate the recovery clacks we have no scientific basis for the interventions. thank you. >> thank you doctor johnston you are recognized. >> ranking members of the committee thank you for inviting me to testify before you today a long side of the panel about our experience in alabama. >> can you pull the microphone a little bit closer? our experience following the passage of the concussion legislation as well as the work that we are doing at the university of birmingham to improve the sports safety in the state of nebraska that sports and football are an extremely important part of the culture and as a result we take the safety very seriously as well. as it is known the problem has gained prominence over the past decade thanks to the research and worked on by the scientist physicians and in public health professionals as many centers in the united date into the work of

public officials highlighted in the research is significant concern in the studies have identified potential long-term consequences including depression, traumatic neurodegenerative diseases associated with the impacts. while college at professional football gets the most attention it's important to keep in mind 70% of all of the football players are under 14 years of age and any directed effort on the impact sports will need to address these off leads. parallel to the enactment of the concussion law in 201 wall and y states the alabama state concussion task force and think first alabama initiated a concussion education awareness program and it worked. in the first year we observed a 500% increase in the referral of the youth athletes referred to become a neck and the children of alabama. they felt the study was about 350 youth athletes seen every year. this rapidly increasing patient population we developed a

multidisciplinary protocol. it's in the appendix number one and following the consensus guidelines they were evaluated with expertise and concussion kept out of sports until they were symptom free and returned to make a referred when appropriate and supervised the return to play and returned to think program a formal study in 2012 demonstrated that establishing the program resulted in significantly better care and decreased institutional resource utilization. even though the efforts have resulted in improved recognition and alabama and other states we believe much remains to be done to prevent a sports related injury in the first place. given the difficulty of the concussion threshold it has been said previously using existing technology and other subjective ways of evaluating athletes the research has begun to widen the focus from concussion to correlating the cumulative impact exposure over time with changes in the imaging techniques and nero psychological changes even in the absence of the diagnosed

concussions. because of the impact they've demonstrated problemtheydemonste learning and the cognitive impairment and as it is seen also with football players compare every control and those that have not had these injuries. the definitive conclusions about the impact frequency headcounts cannot be drawn from the studies. it's become clear that some of the impacts that is those that do not result in the concussion play a role in the injury and need to be studied. they suggested a significant portion of the head impact actually takes place during practice and the largest impacts have been to take place during the practice is a lot of times during outdated drills that were supervised by the well-meaning coaches in the lading top-level programs which don't do these practices in the teams like the university of alabama and others the alabama high school association recently published the guidelines to limit full contact practices to twice per

week. this intervention is complementary to what the football is talking about the techniques not just the techniques of hitting but also the hitting practices per week as well as what drills are going to be done during the practice. they've instituted guidelines to this but that is a small section. in the frequency of the practices as well as the type of the drills would have a large effect on the safety significantly decreasing the exposure for every football player in america. it's become clear that the standards defined by the national operating committee for standards and athletic equipment must be updated to improve the understanding of the concussion and it's clear that the linear impact in declaration played a role in the concussion physiology and the linear impact is studied by the system which is from the skull fractured developed in the 1960s. we believe that having the multiple other more complete picture of the impacts that are seen in the football field are

necessary to come up with a meaningful standard in collaboration with the football program engineers led by the dean previously the university of the brusca and develop the safe barrier have recently developed a robust video analyzes system to analyze impacts and re-create them in a purpose built lab. in conclusion the passage of the legislation community education advancement in understanding have had exposure in the youth have all improved the safety of the impact sports and we are recognizing the concussions more frequently and much work remains in the concussion education and drafting the policy to limit the exposure for the athletes and contact sports. as a part of the multifaceted complex problem i believe that the development of the helmet standards is crucial for the development of safer helmets. thank you for the opportunity to testify. >> you are now recognized for five minutes. >> i would like to thank the subcommittee for inviting me to testify today. i am speaking to you as a football fan who happens to be a

physicist. my main professional interest is the understanding of how the protective equipment works and how it can be improved. today i wish to consider the several aspects that are problematic as far as concussions go into how we might move forward to make the game safer. american football is an inherently violent sport. that's one of the reasons we love it and that is one of the forces encountered in football can be huge. consider the hate between the running back and linebacker at full speed we can show using the second law to force each player exerts on the other exceeds three quarters of a time and this is why football is called a contact sport. the two players that collide at full speed are experiencing the same force to their heads one of them would feel if he had a 16-pound bowling ball dropped on his helmet from the height of 8 feet. medical knowledge of concussions

is in its infancy but we have one thing for sure, the forces to the head and neck cause concussions in with just how we heard the big forces can be here is another problem. they are getting bigger. since 1920 the average way of the pro- alignment has increased almost 60% to just over 300 pounds. at the same time they've gotten about 10% faster. combining the factors of the speed and mass to calculate the energy available to cause injury we find that the amount of energy dumped into the pit after the line of scrimmage on any given play has almost doubled since 1920. the players are shedding their protective gear. buying the knee pads to use to be centimeters thick now bear a remarkable resemblance to teacup doilies rated most popular alignment with my generation have gone the way of the flying wedge. modern helmets or technological marvels the players choose them

up for their coalition ability but for how cool they look. another problem is the poor state of the medical knowledge. while not confident to explain these issues, i think that it's safe to say that a roomful of the trauma physicians will not agree on the details of what concussions are or what causes them. this means the diagnosis and treatment has a long way to go. as our understanding of the issues improve, we may find that rates due to the increasing energy of the game and the wholesale shedding of equipment have increased faster than we thought. finally if the busines businessd professional levels when monetary forces manifest themselves as they do for example in the bounty programs into illegal doping the game becomes more dangerous. what are the solutions? we need better equipment but this can get tricky for example adding more foam to the outside

of the helmet will lower the force delivered to the players skull. this has been tried in the past. the problem is that the added padding increases the helmeted diameter as well as the friction meaning that the opposing player can exert a lot more torque on your head. nonetheless, several companies today are proposing the same basic padding idea for the youth football for whose risk of collision to the head is almost certainly greater. the use of a star system and the hitting system for the modern cushions to the head represent important first steps towards improving football safety. for a variety of reasons that disregarded their safety, they are largely ignored. our understanding of the physiological and epidemiological related concussions must be improved. there's now an understanding in the nfl and the college level that significant research in this area is needed. several members of the panel

including my colleague from the brusca are leading cutting-edge efforts in this area. finally, some incremental rule changes and more stringent and for some of its existing rules are needed. in my opinion some of the rules regarding the targeting peel back blocking into the definition of the defense opponent are making players were hesitant on the field. they may actually increase the risk of injury. the changes should be studied and possibly reversed. it's my belief that the return to the level of the padding worn in the 1970s would make the game to the country safer. a more thorough they should be developed and actually enforced. the nfl season should be reduced to 14 games in the college season returned to 11. finally, more stringent requirements regarding one can return and need to be implemented. these are my thoughts for your consideration. thank you for your attention and

valuable time. >> thank you for your valuable time. i appreciate you being here. you are recognized for five minutes. >> thank you chairman or ranking member schakowsky and members of the subcommittee. i appreciate the opportunity to speak on behalf of the safety of our children in this country. so, i'm a pediatric narrow psychologist at the children's health system here in washington, d.c.. and the director got the score concussion program. i'm a clinician, researcher in the public health educator. today i would like to take my time to focus my comments on the importance of public health education for the concussions using my expertise as a clinician and researcher. and i looked for the last decade with the cdc on their heads up concussion program materials. we all know, and i think that gm said it perfectly that the sports recreation provided input

for developmental opportunities to enrich the lives of the youth and to teach life lessons. but we have to balance those benefits of the purpos the presn with careful attention to the safety issues in science must drive our action oriented approach. they have injuries to the brain that threaten the development of the u.s. and in the attempt to protect the youth we now have the walls in all 50 states and the district of columbia with a good intent of predicting our student athletes through the rules with educating coaches and parents and removing the suspected concussions and not allowing them to return until properly cleared. all states including high school at this level but only 15 out of the 51 include the youth sports. so less than one third are looking at the majority of the athletes. into the testimony, i was posed with an important question and challenge with a sports. the sports. with concussion awareness at an

all-time high the sports teams and organizations to short out what to do about it and the simple answer to that question with my experience is yes. many are not equipped to know what to do with a suspected concussion. mechanisms to teach the active recognition with every coach and appeareare inconsistent and limn scope. the holding of safety is largely in the hands of the coaches and parents at some level. they need medically guided training in the early identification of concussions in the protection. coaches and parents must receive training and action oriented recognition response. awareness isn't enough and they have to be prepared properly. we know that as you heard repeated concussions present the greatest challenge to the youth. for the greatest challenge is the universal and effective implementation of the law so that we can prepare the coaches and the parents to know what to

do and have the tools with which to do it. at the national health system over the past ten years come of the program has delivered hundreds upon hundreds of action oriented paradigm to coaching educated training programs using the heads-up material from the cdc. we have learned much about the community needs and how to deliver the message. so we deliver scenario training where we present to the coaches and parents and actual situation and what they must do to recognize and respond. this is all very important as we put these responsible adults in place. you have heard about some important other activitie activo good examples of head safe action and had a smart action such as the heads-up tackling program where the coaches are educated and concussion recognition response that they are also taught techniques that we be we can improve taking their head out of the game but

we have to go further in all of the youth sports. we do not have a couple coordinated strategy at this point for the action oriented solution methods to recognize and respond to these injuries. we have the tools and programs but we do not at this point have a delivery mechanism to do that. so, we have to build also on the active partnerships between the youth sports organizations and medical care systems. confessions are complicated. they are not simple. we are not asking them to be clinicians and go out and diagnose. we have willing teammates as you've heard through the affordable lacrosse, hockey, rugby and other organizations. but we need to build those partnerships and we need the help of the professional sports leagues as you are hearing from the nhl and the nfl and of course manufacturing world to team up with us. we also need a quarterback ultimately to be able to make this happen. we have to leverage the efforts of the other organizations like the national council on the

youth sports safety alliance comcommittee brain foundations n all of this is important for us to do. so we need obviously the funding to do that to move forward. can we move from awareness action guess we can. they are serious injuries that threaten the youth that we do not need to be scared away from that. we do not need to avoid the developmentally appropriate participation in sports activities to read what we need to do is focus on how to teach the recognition response. and our country needs a good universal mechanism to implement the community focused solutions. and we leave that that can help children ultimately as they enjoy the benefits of sports. our motto applies here. this is play hard, play safe, but play smart. >> very good. you are now recognized for your five minutes.