Now that nearly every state has passed some form of youth-concussion law, what's next?
A study published online Thursday in the American Journal of Public Health compared the slate of youth-concussion laws enacted between 2009 and 2012 to see where states stand to improve.
In that four-year timeframe, 44 states and the District of Columbia passed youth-concussion laws, according to the study. A handful of other states have since passed such laws in 2013, with Montana and West Virginia being the two most recent to join the youth-concussion-law club.
The study found that most states' laws contain all three major provisions of the National Football League's model legislation, Washington state's Lystedt Law, which was passed back in May 2009. Those three provisions are: Requiring parents to sign a concussion-information form before their student-athlete can participate in sports; requiring any student-athlete suspected of a concussion while playing sports to be immediately removed from practice or a competition; and mandating that any student-athlete who sustains a concussion must obtain medical clearance from a health-care provider before returning. (As you'll soon see, the meaning of "health-care provider" tends to vary on a state-by-state basis.)
To break it down by each provision:
• 41 states and the District of Columbia require any student-athlete suspected of a concussion to be immediately removed from practice or a competition. All of those states besides Wisconsin and Ohio require removal for at least 24 hours.
• 40 states and the District of Columbia require any student-athlete who suffers a concussion to obtain medical clearance before returning. Fourteen of those states allow health professionals who lack traumatic-brain-injury-specific training to perform the medical clearance.
• 33 states and the District of Columbia require parents or guardians to sign a concussion-information form on an annual basis before their child is allowed to participate in interscholastic sports.
Only 25 of the 45 jurisdictions included in the study require some form of concussion training for coaches. None of the laws "define exactly how such coach-education efforts should be structured," the study found.
Moreover, 16 states' laws include some form of liability limitation or exculpatory provision, which provides legal immunity in states where student-athletes and/or families could sue schools, coaches, or health professionals based on a response (or lack thereof) to a youth-sports injury.
While many states' laws mirror the major provisions of Washington state's Lystedt Law, there's clearly some variation throughout.
The study notes that generally speaking, youth-concussion laws have "generally taken a one-size-fits-all approach," failing to incorporate "scientific consensus that youth concussion vary on the basis of age, the type of sport, and whether the athlete is male or female." Previous research has suggested that girls and teenagers may be more prone to suffering headaches months after suffering a traumatic brain injury (TBI), for instance.
Also, no state's youth-concussion law currently targets sports-specific rules, such as prohibiting certain types of contact. Certain youth sports organizations have taken matters into their own hands, however.
The Arizona Interscholastic Association recently decided to restrict coaches from holding more than half of preseason practices in full pads and more than one-third of regular season practices in full pads. Texas' University Interscholastic League will take up a proposal next month that would limit the amount of full contact allowed in high school football practices per week. A study released last year suggests that the hardest hits for youth football players typically occur during practice.
Football isn't the only sport affected by emerging head-injury research. Earlier this month, the National Federation of State High School Associations toughened a handful of ice hockey rules for the sake of reducing the number of injuries student-athletes suffer.
Because states' youth-concussion laws haven't yet begun including sports-specific rule changes, the study concludes that they're "only part of a comprehensive youth sports-TBI-prevention framework." Sports-specific rule changes, advancements in technology, and "identifying the best education programming" could also contribute to such a framework, the study suggests.
"The legislative response has been rapid, but it remains a work in progress," said study author Hosea H. Harvey, an assistant professor of law at the Temple University Beasley School of Law, in a statement. "These laws admirably focus on secondary-level prevention, but more should be done to address primary prevention in vulnerable youth athlete populations."
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