The fact concussions have gained some much attention is both good and bad. On one hand, more focus on traumatic brain injuries (TBI) allows for further research and legislation. However, the fact concussions are so prevalent raises concern on how our children can play sports safely. Obviously, concussions encompass many more individuals than young athletes, however my focus is on this population, as legislation for safe concussion protocols varies by a huge amount in each state. So, since every state has some form of concussion legislation, what’s the point of pushing for federal standards?
State laws protecting children from concussions are nothing particularly new. In 2009, the hallmark Zackery Lystedt Law was passed in Washington. Zackery was injured in a football game after receiving a suspected concussion. After a timeout, he returned to the game. However, he soon collapsed after the game, and had to be airlifted to a local hospital. Zackery was in a coma for 3 months, and had to relearn how to talk, eat, and walk. Even 10 years after his injury, Zackery still has limited control of his left side.
Being the first state to pass a comprehensive protocol for children with concussions, many other states quickly followed suit. There are four major pillars in this law which many states have since used as the backbone of their legislation:
- Guidelines/Education – Requires school districts and corresponding state activities associations to develop a concussion guidelines, with education for coaches and parents.
- Consent – The athlete participating in a sport AND a parent/guarding must sign a concussion information sheet every year, prior to participating in any sport activities.
- Immediate Removal – This portion has been adopted by the NFL as part of their concussion protocol (as we all know too well). This requires any athlete suspected of a concussion to be removed from play, AND:
- Written Clearance to Return to Play – Prior to returning to a game or practice, athletes must first:
- Be evaluated by a health care professional (different by state) with training in concussion management, AND:
- Receive written clearance to play from that same provider
The problem is, not all states have adopted such stringent requirements for young athlete concussion protocols. For example, Wyoming doesn’t specify guidelines to follow on handling suspected concussions, or education regarding concussions. On the Wyoming High School Athletic Association website, there are position statements and “suggested” reading for parents to look at. There is no mandate on what exactly to do when an athlete has a suspected concussion. In fact, this is only recommended information, and parents don’t even have to sign the form!
Compare that information to the forms found on the Washington Interscholastic Activities Association website. On this site, there is a form with concussion information for parents/student athletes to read. Both parties must sign the form prior to beginning any sport. Seems like a big difference concussion management, right?
Obviously, everyone wants what is best for the athletes in their states. We also want to decrease the incidence of concussions, and improve immediate management after a concussion, but I believe we need a more nationwide standard that all states must follow. If every state can follow all the requirements of the Zackery Lystedt Law, then we can truly begin our fight to prevent concussions.
What would this blog be without talking about real legislation? Let’s look at a current bill that aims to tackle the issue of federal regulation of concussion management.
Senate bill S-988, known as the “Protecting Student Athletes from Concussions Act of 2015,” was introduced by Sen. Dick Durbin (D-IL) in April 2015. Being a ranking member on the Democratic side of the aisle (Majority Whip), this bill already has some weight behind it. It was referred to the Committee on Health, Education, Labor, and Pensions, where it currently sits awaiting a committee hearing. *Interestingly enough, this commitee has TWO presidential candidates on it, Bernie Sanders and Rand Paul!
The bill itself is grounded in four major pillars. Those pillars are described below:
- Education – Requires each state to train sports personnel, coaches, athletic trainers on signs/symptoms of concussions, and management of concussions. Also requires release forms for parents and athletes with up-to-date information on concussion risk and management
- Posting Concussion Information – Requires all middle and high schools to post information about concussions at school and on their website. This information is based on current peer-reviewed evidence, and also includes risk, immediate management, signs/symptoms, and the effects of concussion on academic performance.
- Response – Requires all schools to have a designated healthcare provider to detect possible concussions. These providers will immediately remove the athlete from play, keep them out for at least one day, and requires written release from a healthcare provider prior to returning to any sports activities.
- Return to Play – Requires a written release from a healthcare provider that states the athlete is capable of resuming sports, and may include a treatment plan to reintegrate sport activities.
These requirements seem very fair, and are more strict that what many states currently have in place. Another piece of this bill addresses penalties for noncompliance with these requirements, which is lacking in many, many states. If a state were found to be noncompliant with this concussion regulation, the Secretary of Education will reduce federal funding to the state by FIVE PERCENT the following year. WOW. Further noncompliance the following year decreases federal funding by ten percent. That’s a real incentive to follow the rules!
If this bill were to pass, I think one major change needs to happen. Under “Healthcare Providers,” only MDs and DOs are currently listed as trained providers. As a physiotherapist, I strongly support an amendment that would include physiotherapists to this list. The NFL already has PTs on the sidelines, why not in high school too?
With this in mind, I think the APTA and all physiotherapists should strongly support this legislation. Without federal standards for concussion management, I’m afraid many young athletes will not get the care they need, or their symptoms may be overlooked entirely.
What do you think about this bill? Have any points you would like to discuss? Sign up for my email list today, and follow me on twitter @tylerDPT!