How widespread are concussions among youth athletes?
An estimated 400,000 high school athletes sustained concussions while participating in five major male sports and four major female sports during the 2005-2008 school years.iIn addition, experts believe that the prevalence of sports-related concussions among young people in all sports is significantly higher than reported.
Moreover, the number of youth athletes taken to emergency rooms with sports-related concussions doubled during the 10-year-period from 1997 to 2007.ii Meanwhile, among youth aged 14 to 19, emergency room visits for concussions sustained during team sports more than tripled over the same period.iii
What dangers do these head injuries pose to young athletes?
A concussion is a type of traumatic brain injury, or TBI, which changes the way the brain normally works. Recognizing and responding to concussions when they first occur helps to aid recovery and to prevent prolonging concussion symptoms, chronic brain damage or even death. Yet, a recent study estimated that more than 40 percent of high school athletes return to participate in school athletics before they have fully recovered from these serious head injuries.iv
Do concussions involve youth athletes in all sports and at any age, or is it just an injury sustained by boys who play football?
Concussions can occur in athletes of any age and in any sport or recreational activity. In fact, each year, U.S. emergency departments treat an estimated 135,000 sports-related and recreation-related TBIs, Including concussions, among children ages 5 to 18.v In addition, children and teens are more likely to get a concussion and take longer to recover than adults. While youth sports concussions often are associated with football, the rate of concussions in girl's high school soccer is almost as high. Research also indicates that there may be gender differences in how boys and girls recover from concussions.vi
How many states have enacted laws related to concussion awareness, prevention and management?
As of March 2013, 47 states and the District of Columbia have joined Washington in adopting concussion awareness and prevention legislation, known as Zackery Lystedt laws, including Alabama, Alaska, Arkansas, Arizona, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, West Virginia and Wisconsin. In many other states, active coalitions are pushing to enact similar legislation.
What are the key elements of a concussion prevention and management bill?
An effective concussion prevention bill follows the example of the state of Washington's Zackery Lystedt law. It includes three essential elements: (1) inform and educate student athletes, their parents and guardians and require them to sign a concussion information form; (2) removal of a student-athlete who appears to have suffered a concussion from play or practice at the time of the suspected concussion; and (3) requiring an athlete to be cleared by a licensed medical professional trained in the evaluation and management of concussions before returning to play or practice.
There is an international consensus on return-to-play guidelines for youth, adopted at the 3rd International Conference on Concussion in Sport in Zurich, in November 2008, which states that "It is not appropriate for a child or adolescent athlete with concussion to RTP on the same day as the injury regardless of the level of athletic performance."vii
What is the cost of implementing a concussion prevention and awareness bill?
Zero. The bill is revenue neutral. There are no mandates in the bill and no requirements that resources be spent to hire or train medical professionals or to purchase equipment. Free information on concussions for high school and youth coaches, parents, athletes, as well as school professionals is publicly available on the Centers for Disease Control and Prevention's (CDC) website at www.cdc.gov/Concussion, including a youth concussions poster found at www.cdc.gov/concussion/pdf/poster_Eng.pdf designed to hang in every locker room across the country.
What are the penalties for violating the concussion prevention and awareness law? Who is liable if the law is not followed?
There is no liability attached to Washington's Zackery Lystedt law. It does not mandate any civil or criminal penalties, nor does it create greater liability for individuals and/or organizations. Indeed, the education and awareness efforts and requirement of medical clearance before return to play has decreased the variability of care and decreased liability. Wherever the law is passed, the community can determine if and how to monitor and enforce the law.
What about implementing the law in rural areas where it may be more challenging to find medical professionals?
The law does not require a specific medical specialist to participate in every evaluation. Rather, the language of the Washington statute requiring an athlete "to be cleared by a licensed medical professional trained in the evaluation and management of concussions before returning to play or practice" permits a wide range of qualified individuals to determine a youth athlete's suitability for returning to play. For example, in Washington tate, the Washington Interscholastic Activities Association decided that qualifying medical professionals included: medical doctors, osteopaths, nurse practitioners, athletic trainers and physician assistants.
What is the impact of concussion prevention laws on private sports organizations?
These laws may be written in such a way as to apply not only to public sports organizations but also to private sports organizations, many of which maintain public-sector connections/affiliations (such as the use of public facilities). For example, in Washington private sports groups are required by law to carry insurance to play on publicly-owned playing fields. The Zackery Lystedt law amended that insurance-based law to require private nonprofits to comply with the policies on the management of concussions and head injuries in youth sports.
What impact have concussion-prevention laws had in states that have passed them?
The Zackery Lystedt law was the first concussion-prevention state law to pass in 2009. While no comprehensive and detailed assessment can yet be made, early and anecdotal data suggests that the law is having an immediate and positive impact. It is helping meet a critical goal -- preventing preventable brain injuries and making sports and recreational activities safer for youth.
What organizations have supported such measures?
A broad coalition of groups representing teachers and parents, sports medicine, medical professionals, school administrators, the disability community and athletic organizations have supported concussion prevention legislation at the state and federal level. These organizations include the National Football League, American College of Sports Medicine, USA Football, Parent Teacher Association, National Association of School Nurses, National Council of Youth Sports, The Sarah Jane Brain Foundation, National Disability Rights Network, National Athletic Trainers' Association, National Association of Health and Fitness, the Brain Injury Association of America, the Brain Injury Association of Washington, and many others.
What law, if any, has Congress proposed or passed regarding concussion prevention and awareness?
The "Protecting Student Athletes from Concussions Act of 2010? incorporates the same core principles of the Lystedt law and was introduced in Congress in September of 2010. If passed, the bill would require school districts to develop and implement a minimum standard, community-based plan for concussion safety and management. Of course, states would be able to implement standards far exceeding these basic, minimum standards.
Where may I find/read a copy of the Zackery Lystedt law?
Where may I find more information about the dangers of concussions and passing a law in my state?
More information about concussions may be found on the website of the CDC. You also may watch an NFL-produced video about enacting a concussions-prevention law in your state, which is available at NFL.com/youthconcussions and on the CDC's website as well.
- Nationwide Children's Hospital, Concussions Clinic, Ohio State University
- Bakhos L., Linakis J., et al. "Emergency Department Visits for Concussions in Young Child Athletes," Pediatrics, 2010.
- Center for Injury Research and Policy at Nationwide Children's Hospital, Columbus, Ohio
- Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention, 2007.
- Journal of Athletic Training, 2007
- McCrory P, Meeuwisse W, et al. "Consensus Statement on Concussion