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Federation Forces States' Hands on Youth-Concussion Action

Recently, I reported that 31 states and the District of Columbia now have youth-concussion laws, with 11 more states currently working bills through the legislative process. That left only eight states—Arkansas, Florida, Georgia, Hawaii, Kentucky, Mississippi, Montana, and West Virginia—that were taking no legislative action at the time.

Thanks to the National Federation of State High School Associations, those eight states have been acting on youth concussions after all, although not necessarily through the legislative route.

In 2008, the NFHS Sports Medicine Advisory Committee advocated that all concussed student-athletes be immediately removed from play and not allowed to return on the same day. Then, in October 2009, the NFHS board of directors approved a concussion policy Requires Adobe Acrobat Reader that calls for student-athletes suspected of a concussion to be removed immediately from play and requires medical clearance before they return. Said policy appears in all NFHS rules books for the 2010-11 school year.

While the NFHS lacks the power to mandate "activity that occurs inside or outside the confines of a game, match, event or contest," it does strongly suggest that states develop a return-to-play policy for concussed student-athletes; educate parents, coaches, and student-athletes about the risks of concussions; and make those parties aware of current state laws regarding youth concussions.

The federation also made a free online course available, called "Concussion in Sport—What You Need to Know," which more than 200,000 individuals have now taken, according to a press release from earlier this month.

The NFHS might not have the teeth that the NCAA does to help enforce its suggestions, but that hasn't stopped states from taking action in response to the national federation's changes in concussion policy. Here's a summary of what the state athletic associations of each of the eight states has for a concussion policy:

Arkansas: The Arkansas Activities Association's board of directors adopted a set of concussion guidelinesRequires Adobe Acrobat Reader on Aug. 4, 2010. The policy prohibits student-athletes suspected of having a concussion from returning to play on the same day, requires those athletes to get medical clearance before returning, and suggests a "step-wise protocol" upon returning to play.

In January of this year, the AAA issued a statementRequires Adobe Acrobat Reader saying that "head injury and concussion education, prevention, and management efforts must remain a top priority" in 2011.

Florida: Back on June 14, the Florida High School Athletic Association posted its new concussion action planRequires Adobe Acrobat Reader online, leaving the door open to amendments in September by the association's Sports Medicine Advisory Committee.

The Florida association requires any student-athlete that shows signs, symptoms, or behaviors of concussions to be removed from play immediately and prohibits said student-athletes from returning until they're cleared by an "appropriate health-care professional." It also suggests a step-wise return-to-play protocol, much like the Arkansas Activities Association.

Georgia: The Georgia High School Association reacted to the NFHS' new concussion policy by revising its own on Aug. 2, 2010. The GHSA started requiring student-athletes suspected of having a concussion to be evaluated by an appropriate health-care professional that day.

If the medical professional doesn't diagnose the student-athlete with a concussion, he/she would be allowed to return to play. If the student-athlete was diagnosed with a concussion, he/she would have to sit out and obtain medical clearance before returning. Either way, the policy appears to go out of its way to clear coaches and officials/referees of any liability, saying that neither is expected to diagnose concussions.

Hawaii: The Hawaii High School Athletic Association attempted to go the legislative route. A billRequires Adobe Acrobat Reader was introduced earlier this year in the state legislature that called for the state education department to consult with the HHSAA to develop a concussion-education and -management program.

At a minimum, coaches would have been required to undergo annual concussion-recognition training, parents would have had to sign a concussion and head injury information sheet before a student-athlete could participate in interscholastic sports, and the same removal-from-play/return-to-play guidelines as the other states have would have applied, too. The legislation was deferred on Feb. 4.

Kentucky: The Kentucky High School Athletic Association quickly implemented a new concussion policyRequires Adobe Acrobat Reader in response to the NFHS rule change last summer. The KHSAA prohibits student-athletes with concussions from returning to play on the same day and requires them to obtain medical clearance before returning to practice or competition.

The KHSAA's new policy also includes this "fundamental reminder": "It has always been the ultimate responsibility of the coaching staff, in all sports, to ensure that players are only put into practice or contests if they are physical [sic] capable of performing." (The association has a whole section of its website devoted to concussion information.)

Mississippi: The Mississippi High Schools Activities Association approved recommended guidelinesRequires Adobe Acrobat Reader from its Sports Medicine Advisory Committee in May 2010, before the NFHS' action. The MHSAA's new policy requires any student-athlete suspected of having a concussion to be removed from play immediately and does not allow said student-athlete to return to play that day, no matter what.

If a student-athlete has a concussion, he/she must obtain medical clearance before returning to play. The MHSAA, like the state athletic associations in Arkansas and Florida, recommends a gradual return-to-play after a concussion, and says that a student-athlete "should not return to a competitive game before demonstrating the [sic] he or she has no symptoms in a full supervised practice."

Montana: The Montana High School Association's concussion policyRequires Adobe Acrobat Reader places the ultimate responsibility with the coach, much like in Kentucky. Officials are expected to familiarize themselves with concussion symptoms and warn coaches when a player becomes symptomatic, but the final decision rests with the coach after a medical professional checks out the student-athlete on the sideline.

The MHSA's sports-medicine section of its website contains one of the more comprehensive concussion education centers you'll find on a state association's website. It includes information for coachesRequires Adobe Acrobat Reader, teachersRequires Adobe Acrobat Reader, nursesRequires Adobe Acrobat Reader, and an athlete fact sheetRequires Adobe Acrobat Reader, among many other resources.

West Virginia: The West Virginia Secondary Schools Activities Commission adopted a revised concussion policyRequires Adobe Acrobat Reader, in May 2010 (much like Mississippi, pre-empting the NFHS by a month), where it calls for any athlete who displays signs of a concussion to be immediately removed from play and evaluated by a health-care professional. The student-athlete would only be allowed to return if a health-care professional was available and determined that the student-athlete did not suffer a concussion.

The WVSSAC actually spells out its suggested return-to-play policy, which mirrors that of the one detailed in the 2008 Zurich Concensus Statement on Concussion in Sport. The five-step return-to-play model requires that athletes remain symptom-free for 24 hours to advance through a protocol of light aerobic exercise, sport-specific activity, noncontact training drills, full-contact practice, and finally, return to play.

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