Infographic showing what happens during a concussion. Seattle Times/2016

During Daniel Longoria’s helicopter ride to UAB hospital, he wasn’t sure what was happening — but he felt he might be getting abducted by aliens.

The then-senior offensive lineman at Alexandria High School had just suffered a concussion during a preseason scrimmage. He was in and out of consciousness, had a tube put down his throat and had strangers prodding him.

Although he has since recovered, it was a scary time for the Longorias and the Alexandria football team. His twin brother, Joshua Longoria, couldn’t bring himself to go to the hospital at first.

“When this happened, you almost thought he was dead,” Joshua said. “He was barely breathing, he was unconscious, he wasn’t responding. We couldn’t get him to wake up no matter what he did.”

Concussions and how high school sports teams handle them have become a much more serious issue from the days when coaches simply said an athlete “got his bell rung” and allowed him to continue playing.

While the National Football League wrestles with how to diagnose and treat concussions, high school football teams are no different.

A concussion is defined by the Centers for Disease Control and Prevention as a traumatic brain injury that causes the head and brain to move back and forth, often because of a blow or bump.

According to figures provided by the National Federation of State High School Associations, high school football participation has dropped 2.6 percent from 2009 to 2015, which is the most recent year figures are available.

While the statistics don’t include a reason for the drop, Roger Blake, executive director of the California Interscholastic Federation, told Sports Illustrated, “Think of how far we have come in the last 20 to 30 years when it comes to concussion awareness, tackling techniques, equipment. And yet we’re still having these discussions about declining participation and safety concerns.”

Daniel’s injury was not the first experience the Longorias had with concussions. Joshua sustained one in Alexandria’s jamboree game in 2014. He remembers the exact play.

“I was pulling around to make a block,” Joshua said. “It happened so fast. It was a guy about my size, and instead of raising my arms … I reared back and head butted him in the chest. It was kind of a stupid move, and it rung my bell.”

He felt like everything was moving slower and spinning, but he didn’t tell anyone until the third quarter. His coaches didn’t notice at first because he didn’t seem to have any symptoms.

But when he finally sat down, his symptoms hit. Everything was really loud and bright and an intense headache set in. His teammates thought he might have a concussion when he started acting strange. By the time the trainer came over, he couldn’t stand. Five minutes later, he was losing strength, and his mom, Rebekah Longoria, drove him to the hospital. At Anniston RMC, light caused him to shake.

“They asked me who the president was, and I said Nixon. I don’t know where that came from,” Joshua said. “They asked me what my name was … I told them my name was Big Longo.”

The next morning, he could remember football, but he couldn’t recognize his family or remember his name.

After more than 30 years coaching, Michael Shortt, head football coach at Cleburne County High School since 1998, has seen gradual changes in how concussions are assessed and treated — changes for the better, in his opinion.

“Anything safety-wise that can enhance our game and make it safer for kids, I’m all for that,” Shortt said. “We’re going to do that here.”

Shortt remembers sustaining concussions during his playing days.

“My coaches took care of me then,” Shortt, a 1980 graduate of Cleburne County, said. “They knew something wasn’t right.”

The protocol

Last year, the state limited the number of hours of live contact in which football teams could participate, according to the AHSAA.

Ron Ingram, an AHSAA official, said a school ignoring the state’s concussion protocol is rare. The protocol was adopted by the state Legislature in 2011 to apply to all youth associations. If a doctor, trainer or coach suspects an athlete is suffering from concussion signs or symptoms, such as dizziness or confusion, that athlete is removed from play and cannot return until he or she is cleared by a medical doctor.

“There’s three things the AHSAA puts most importantly,” Ingram said. “One is health and safety. Second, fair play and the third thing is sportsmanship.”

State regulations serve as a baseline for schools’ concussion protocols, according to Randy Beason, athletic trainer at Cleburne County and Alexandria high schools.

Beason uses the Standardized Assessment of Concussion, which measures orientation, immediate memory and concentration among others. He also uses the Balance Error Screening System, to assess potential concussions. An athlete is assessed a day later. After Beason observes concussion-like symptoms, he takes the athlete out of practice and informs the parents and coach. A physician then takes over and determines the next steps. Beason typically will enact the concussion protocol if he observes more than two symptoms.

“I treat them like my own child,” Beason said. “If I’m not going to let my child play, I’m sure not going to let anybody else play.”

At Cleburne County, Shortt will keep a player with a concussion out for at least seven days.

Athletes who suffer a concussion need brain rest, which extends beyond the football field, according to Michael Herndon, who served as team doctor at Jacksonville State University for 10 years and Alexandria’s team doctor for 17.

“Our typical protocol is if you get a concussion … shut it down, do nothing, no exercise, no contact, no nothing, until all neuro symptoms abate,” Herndon said. “That may be days to weeks, depending on the kids.”

After symptoms abate, Herndon looks at how long symptoms lasted and determine when athletes can be eased into play. If there are no symptoms after days of exercise, the athlete can return.

“Everybody wants that crystal ball answer, when can I go back,” Herndon said. “Well, when you quit having neuro symptoms. And that’s different for every individual and that’s even different for every concussion.”

Issues with self-reporting

Ingram said coaches and trainers are taught to recognize symptoms because athletes won’t self-report.

Beason said athletes not self-reporting concussions are only hurting themselves.

“Football’s never worth dying over,” Beason said. “I don’t care who thinks it. I would prefer them to self-report it. That way it’s less damaging to everyone, team included.”

Shortt said that is why it is important for coaches to know their players and be able to spot the signs of injury.

“The athlete that really wants to be there … they’re not going to report an injury,” Shortt said. “That’s why it’s important for coaches to know your kids.”

Beason has had parents try to go over his head, but he typically is able to talk to them.

“They may only play sports in high school,” Beason said. “They’ve got the rest of their life to live, including a family.”

According to Ingram, the AHSAA member schools came up with the rules, and the AHSAA simply enforces them. Coaches are required to receive training to recognize concussion symptoms because he said most injuries happen in practice.

The effects

Though Daniel’s injury looked worse, Joshua had the worse concussion because he stayed in the game.

“(Joshua) scared us in the long run; Daniel scared us in the short run,” Gary said.

Both brothers received outpatient treatment at the concussion clinic at UAB. Rebekah said this helped them understand more of what was happening with Daniel’s concussion.

“They actually got our names mixed up a couple times,” Joshua said. “Because they thought it was me coming back for more appointments when it was actually Daniel.”

Joshua’s injury had lasting effects. Most of his childhood memories come from photographs and others’ accounts. He experienced some personality changes, too. He called himself a “book nerd” in the past, but is more impulsive now.

He suffered another concussion in a car wreck and was diagnosed with post-concussion syndrome. He had concentration issues and sometimes his vision would go black and white.

“Basically, it was like my head resetting itself,” Joshua said.

The whole experience was overwhelming, especially the depression that can come with head injuries, according to Daniel. School was especially difficult for Joshua because of all the people he didn’t recognize talking to him. Not being on the field hurt for the brothers. However, they had a support system of friends to help them through. Without his group, Joshua thinks he might have had a “meltdown.”

“I actually had my buddies, they would walk with me around to every class, and if I started getting a look on my face, they knew I was starting to go into panic mode because I was scared,” Joshua said.

Daniel added that the group of offensive linemen jokes around a lot. Said Joshua: “They really helped us become strong again.”

More than preps

Concussions affect more than just football, according to Ingram, who cited examples of people getting concussions from using their heads in soccer.

“The whole purpose is to make the game safer,” Ingram said. “It’s not just football, it’s all sports.”

Concussions are diagnosed more often now because people know what to look for, according to Beason. Diagnosing concussions is much different now than as recent as a decade ago, according to Beason, who called it a “night and day” difference.

“Back then, you could get your ‘bell rung’ and when symptoms subsided, hey, we may let you go back in,” Beason said. “That’s not the case now.”

Shortt said bigger and stronger athletes are affecting the game. He stressed the importance of teaching proper tackling and using safe equipment.

“Any coach that doesn’t spend his money on good equipment is crazy,” Shortt said.

And that extends beyond concussion protocols, Ingram said. Coaches must also take a class on heat safety and learn the signs of someone going into cardiac arrest. They also must have a current certification to perform CPR and use an Automated External Defibrillator.

Beason believes concussion safety extends beyond high school. He said parks and recreation coaches must receive concussion safety training now.

“You’ve got some parents out there, old-school dads, that remember, ‘Hey, I got hit like that before, and I’m fine,’” Beason said. “Well, just how fine are you? At the same time, the education is there, we’ve just got to utilize that education.”

Love of the game

Through his sons’ experiences, Gary has learned a lot about concussions. He now thinks concussion patients should stay out longer. As Daniel and Joshua were preparing to return to football, many of the tests assessed reaction time. Joshua was held out even after he had no physical symptoms for a while because his reaction time was still slower than normal.

“These tests they do pick up on subtle things,” Rebekah said. “They know your brain’s not completely healed yet.”

Rebekah, who is a registered nurse, had a hard time relaxing at the Valley Cubs’ football games after the concussions. Gary and Joshua said Rebekah was always calm during crises.

“I told the doctor, ‘I live to watch them play ball,’” Gary said. “If the doctor told us, ‘It’s over. He can’t play any more.’ it was going to be a hard decision, but we were going to accept that.”

Despite the risks, they still love football.

“To tell you the truth, I wish I had another year to play,” Daniel said. “I kind of miss all the summer workouts and stuff.”

Added Joshua: “The game outweighs the risk. You can get hurt just riding a bike down the road, you can get hurt walking out to get your mail out of your box. If you’re going to get hurt doing something, you might as well be doing something you love.”