WINFIELD, W.Va. -- It may be a headache, nausea, trouble concentrating or increased moodiness. It could be a student who falls asleep in class or an athlete who can't remember how to run a play. The symptoms and signs of a concussion are as varied as the myths surrounding them, and according to Dr. Tony Erwin, being able to accurately diagnose and treat a concussion can be the difference between life and death. That's why Erwin, a doctor of chiropractic medicine and the owner of the Putnam Chiropractic Center, volunteered to serve as team physician for Hurricane High School back in 2005. It's also why he hopes to work with the county's board of education and its middle and high school coaches to spread information about how concussions can be identified and treated. "We can't catch them all, as physicians or trainers, so it has to be a team effort," he said. "We've had kids come up to us on the sidelines and say, 'Hey, go check Billy out. He's talking gibberish,' or 'he's not himself.' We go to check him out -- nobody saw it -- and sure enough, we have to pull a kid out of the game." Concussions are classified as a mild traumatic brain injury, caused when the head is jolted violently, causing the brain to collide with the skull, Erwin said. The impact can cause a lack of blood flow and a loss of glucose for brain cells, resulting in what Erwin calls an "energy crisis" in the brain. "I describe it as like shaking an egg. Even though the shell stays intact, the yolk gets bounced around inside," he said. According to Erwin, false ideas about concussions -- such as the person must lose consciousness or that they have to hit their head -- as well as improper treatment and accommodations for sufferers can lead to longer recovery time and other issues. One major factor in treating concussions is avoiding Second Impact Syndrome, Erwin said. SIS may occur when someone suffers a second concussion before fully recovering from the first, and although it is rare, it can lead to rapid brain swelling and death. "At that point, the brain essentially shuts the body down to try to preserve the last bits of glucose; the kid stops breathing, and he doesn't come back," Erwin said. "That's what we're most worried about." Putnam County employs four full-time athletic trainers at its high schools, according to Superintendent Chuck Hatfield. Each is trained to recognize concussions in an athlete, and state law mandates that student-athletes diagnosed with concussions cannot resume play until they are cleared by an approved medical health professional. "We hired full-time, certified athletic trainers three or four years ago, and I don't know if there is another system in the state that has done that," Hatfield said. "Their entire focus is to take care of our student-athletes." Erwin said he hopes to get every Putnam County middle and high school involved in "ImPACT testing" to ensure better and more informed diagnoses. ImPACT, or Immediate Post-Concussion Assessment and Cognitive Testing, is a computer testing system widely used in college athletics and the NFL. "Science and evaluation is advancing, and it's good that we're trying to keep up," said board member Debbie Phillips. "I think it's a matter of attitude, also -- adjusting and accepting new science." The BOE will hold a meeting Thursday at 1 p.m. with the county's football and soccer coaches to discuss how to best address concussions in countywide policy. Athletes who play football and soccer are the most likely to suffer concussions. Reach Lydia Nuzum at email@example.com or 304-348-5100.