Over the last two years, 31 states have adopted youth concussion laws. The quick pace of these laws’ passage is testament to the increased public awareness of the disastrous effects that concussions can have, especially on brains that are still developing. Of the states with the most high school football participation, only Ohio, Florida, and Georgia have not yet passed such a law. Of the 31 states with a youth concussion law, only five adopted the law prior to 2011, and only one state – Washington – adopted such a law prior to 2010.
Due in part to the efforts of the National Football League – which has promoted the adoption of such laws – each state’s statute shares superficial similarities with the statutes of other states. Most states’ laws reflect the tenets of the NFL’s “Lysedt Law” model legislation, which asks that the law do three things:
- Inform and educate youth athletes, their parents and guardians and require them to sign a concussion information form;
- Immediately remove from play or practice an athlete who appears to have suffered a concussion; and
- Require an athlete to be cleared by a licensed health care professional trained the evaluation and management of concussions before returning to play or practice.
Clearly, there are many ways to accomplish such a goal, and a brief review of the recently passed laws of the two states with the largest high school football participation – Texas and California – reveals several differences in application of the above principles.
The California law essentially mimics the three tenets of the Lysedt Law, but requires little more. The law provides that the athlete “shall not be permitted to return to the activity until he or she is evaluated by a licensed health care provider, trained in the management of concussions, acting within the scope of his or her practice.” But the methodology of evaluation, the “scope of practice” and even what is a “licensed health care provider” remain undefined. Indeed, even the word “concussion” is left undefined.
By contrast, the Texas law is incredibly specific, and requires much more than the broad outlines of the Lysedt Law. Among other things, the Texas law:
- Requires each school district to appoint a “concussion oversight team” which is tasked with establishing a “return-to-play protocol, based on peer-reviewed scientific evidence” which will guide when and whether an athlete will return to the sport;
- Specifies that the members of the “concussion oversight team” must include at least one physician, as well as at least one advanced practice nurse, neuropsychologist, physician assistant, or athletic trainer;
- Requires that the “concussion oversight team” members must have “training in the evaluation, treatment, and oversight of concussions”;
- Specifies the persons who can make the initial determination that a player may have suffered a concussion;
- Requires the student be cleared to play by both the “concussion oversight team” and a physician of the student’s (or student’s parents) choosing, using evaluation methods based on “established medical protocols based on peer-reviewed scientific evidence”; and
- Specifically notes that a coach may not authorize the student to return to play.
But the fact is that although there is much more awareness of concussions and the risk of concussions, there is no “established medical protocol based on peer-reviewed scientific evidence” — and the few that come closest are often contradictory in their recommendations and approaches. Another complicating detail is the fact that for all of the current awareness and concern, there are very few raw numbers available to assess the effectiveness of legislation. For instance, the floor debate in several states’ legislatures included the assertion that 300,000 concussions are suffered nationwide each year. That number is credited to the Center for Disease Control. But the CDC’s only source for that number is a study published in 1991. In that study, the “300,000” number indicates all head injuries in the U.S., regardless of age or whether they were “concussions” in the medical sense, and is based solely on data taken from the National Health Interview Survey — not any empirical data. Moreover, even in that study, the incidence of brain injury ascribed to athletic participation is 20% of the total number of head injuries (or 60,000). None of the state legislation requires reporting concussions, nor requires any agency to compile the data to study the effectiveness of the law over time. In short, while these laws may relieve some of the concern generated by recent events, there is no mechanism in place to determine whether they will actually be effective in protecting high school athletes.
The recent, tragic deaths of retired NFL players Dave Duerson and Junior Seau (both of whom reportedly suffered from dementia), and the lawsuit filed by 2,000 former NFL players against the NFL and helmet manufacturer, Riddell (alleging that the NFL and Riddell concealed information that they had about head injuries in football), focus their attention on NFL football, attention must also be paid on the effect of concussions on young athletes. Recently, Pop Warner Football the nation’s largest youth football organization, which has over 250,000 players, modified its rules of contact to limit the opportunities for head on collisions and other head-to-head contact in Pop Warner practices.
This issue threatens the future existence of the sport of football, as we know it today. More state and local legislation and rulemaking that acknowledges and takes measures to minimize the problems, together with the development of helmet technology to lessen impacts are all issues that all stakeholders in the sport of football should actively encourage and support.