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«CONCUSSION STATUTES AND YOUTH SAFETY Timothy Liam Epstein, Esq. Partner/Chair, Sports Law Group, SmithAmundsen March 10, 2014 CONCUSSION SYMPTOMS A ...»

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Timothy Liam Epstein, Esq.

Partner/Chair, Sports Law Group,


March 10, 2014


A concussion is a traumatic brain injury that

alters the way the brain functions.

Effects are usually temporary, but if not treated

increases the likelihood of suffering a significant

long-term damage.

Although concussions usually are caused by a  blow to the head, they can also occur when the head and upper body are violently shaken.

These injuries can cause a loss of consciousness, but  most concussions do not. Because of this, some people have concussions and don't realize it.

Source, Mayo Clinic http://www.mayoclinic.org/diseases-conditions/concussion/basics/definition/con-20019272 


The signs and symptoms of a concussion can be  subtle and may not be immediately apparent.

The most common symptoms after a concussive  traumatic brain injury are headache, amnesia, and confusion.

The amnesia, which may or may not be preceded by a loss of  consciousness, almost always involves the loss of memory of the impact that caused the concussion.

 Other symptoms may include: a feeling of pressure in the head, confusion or feeling as if in a fog, dizziness or “seeing stars,” ringing in the ears, nausea or vomiting, slurred speech, and fatigue.

Some symptoms will appear immediately, while  others may appear hours, or days after the injury.

Source, Mayo Clinic http://www.mayoclinic.org/diseases-conditions/concussion/basics/definition/con-20019272 


A study performed by the National Academy of  Science revealed that in 2009, 250,000 children below the age of 19 were treated in American Emergency Rooms for concussions.

That number is up from 150,000 in 2001.

 The study was largely funded by the Center on  Disease Control and in part by the National Football League, and examined a broad array of medical studies regarding concussions.

 It is estimated that roughly 300,000 youth athletes suffer concussions a year while participating in sports.


Football  The report found that football caused more  concussions in young athletes than any other sport.

 Further, it found that high school football players were nearly twice as likely to suffer a brain injury as collegiate players.

 The study demonstrated that football helmets, mouth guards, and facemasks offer no substantial protection against concussions.


Non-Football Concussions:

 The study went beyond just football and examined  other sports as well.

 Other sports that posed a significant risk of head injury for high school athletes include baseball, soccer, men’s and women’s lacrosse.

The report called for additional research on how  to diagnose and treat youth athletes that have suffered head injuries across youth sports.


CONCERNS Growing concerns over the risk of concussions  and the frequency with which they occur in youth sports has generated a legislative response.

 To date every state legislature has passed a youth concussion statute regarding how to prevent, diagnose, and treat concussions in youth sports.

Mississippi, the final state to pass such a statute,  passed its statute in January of 2014, but the law will not take effect until July 1, 2014.

Additionally, many leagues, schools, and athletic  associations have established their own concussion policies.


Each individual statute varies in construction,  however, certain principles are common amongst

the majority of states:

Rules regarding the dissemination of information  regarding head injuries  Training for coaches, team doctors, and school medical professionals  Return to play policies


Many statutes require schools and athletic  associations to provide coaches, parents/guardians, and youth athletes with guidelines and information about the nature and risk of concussions and head injuries in youth athletics at the onset of each season.


 Educate those involved in youth sports about the risks   Teach coaches, parents, and players how to identify when a possible concussion has occurred.

 Clear up common misconceptions about head injuries.

E.g., Many coaches/players/parents believe a concussion only  occurs when an individual loses consciousness. However, the majority of concussions occur without loss of consciousness.


In addition to providing information, some  statutes and youth associations require players and coaches to sign consent forms.

 These consent forms are meant to ensure that the youth athlete, parents/guardians, and coaches understand the potential risk of concussions, and the rules set in place addressing concussions.



Providing information about the risks of  concussions to athletes and parents does not provide blanket protection from liability on the behalf of coaches, doctors, administrators, and schools.

 By adequately informing the prospective student athlete, the decision to play likely qualifies as an assumption of the risks normally related to participation in the relevant sport.

 It will not protect coaches, doctors, trainers, or schools that fail to adhere to relevant concussion policies.


Example A:

 A student-athlete signs a permission slip to  participate in high school football prior to the season.

The coach provides proper training and instructs the team’s players about proper tackling technique.

During the first game the athlete is suspected of suffering a concussion. The athlete is immediately removed, and not allowed to return to play until meeting each of the requirements enumerated in the relevant concussion policy.

The actions taken by the coach and training staff here  will likely avoid any possible liability stemming from association bylaws and legislation should a subsequent claim be brought by the player.


Example B:

 A student-athlete signs a permission slip to  participate in high school football prior to the season.

The coach provides improper training and does not instruct the team’s players about proper tackling technique. During the first game the athlete is suspected of suffering a concussion. The athlete is immediately removed, but then allowed to return to play despite not being examined by the required medical professional.

Clearly, Example B will trigger liability under most, if not 

all, association bylaws and state legislation should related injuries manifest.

TRAINING Many statutes require all coaches, athletic  trainers, school nurses, and school/team physicians to complete a specific concussion training program before participating.

Training often includes how to diagnose/recognize  symptoms of potential head injuries.

Treating a suspected concussion.

  Proper equipment use.

 In regards to coaches, training may include information on how to teach techniques that lessen the likelihood of concussions.



Some organizations offer specific training for coaches.

Provides educational training for coaches on how to  teach proper techniques, including tackling techniques, in an effort to prevent head injuries.

Coaches can take classes to become USA Football  certified.

Many football leagues and organizations require that a  coach must be certified by USA Football to coach.

 Leagues can become USA Football certified by fulfilling a number of steps, including creating a “player-safety coach” position. The player safety coach’s role is to educate players and parents about safety issues, and to monitor practice and games to ensure the highest level of safety is met.



Receiving training or becoming certified by an  organization does not create blanket immunity for coaches, trainers, or medical professionals.

Individuals must apply their training properly and  follow the respective league, school, and state rules regarding head injuries.

However, it is important to understand that while  coaching safe techniques and following concussion statutes and policies may diminish liability for coaches, it does not ensure the prevention of head injuries while playing sports.

The only way to completely prevent head injuries is not to  play.

Coaching the safest techniques and adhering to  concussion policies may mitigate liability for certain individuals involved.


Why the need for ‘Return to Play’ policies?

 Suffering a concussion increases the likelihood of  suffering another.

 Youth athletes are more likely to suffer a concussion and tend to take longer to recover.

 A repeat concussion that occurs before the brain recovers from the first—usually within a short period of time (hours, days, or weeks)—can slow recovery or increase the likelihood of having long-term problems.



Junior High Football player that suffered a  concussion and returned to the game, three plays later.

Lystedt suffered a significant brain injury requiring  brain surgery to remove the left and right part of his skull to alleviate building pressure from his swelling brain.

Lystedt experienced numerous strokes, spent seven  days on a ventilator and three months in a coma before he awoke.

He would spend four weeks in a nursing home, and  two months in a children’s hospital for rehabilitation.

It was nine months before he spoke his first word, he spent over a year and a half on a feeding tube, and it was three years before he regained the ability to stand, with assistance.


These statutes require a player that has exhibited  concussion symptoms be removed from game play or practice activities.

Athletes are not allowed to return to practice or game  play until certified trainers or physicians have cleared the athlete to return.

Most states require that a medical physician/trainer must  be licensed to practice in that respective state.

 Varying levels of clearance is required, for example:

The Illinois High School Association requires that a licensed  trainer of physician ‘clear the athlete’ before he may return to competition on the same day in which the head injury occurred.

In Wisconsin, an athlete removed because of a suspected head  injury cannot return until evaluated by a physician and receives written permission from the physician to return.


In most states, if a player is barred from  returning to the game or practice the day she is removed, she is subject to a more stringent return to play program.

 These programs often times consist of a series of stages that measure the athlete’s recovery.

The stages often include a period of rest and physical  tests to determine when a player should be allowed to return to play.

 These tests often take several days to complete, and require the individual to return to practice before competing in a game again.



Return to play policies can create significant  liability for coaches and physicians that allow an athlete to return to play prematurely.

Coaches can face personal liability if they ignore the  recommendations of the trainer/team doctor, and allow the athlete to return prematurely.

 Team doctors/trainers can face personal liability if they fail to appropriately diagnose an athlete or fail to adequately communicate with a coach that a player may not re-enter the game.

Further, violations of return to play policies by  coaches and team doctors/trainers employed by a school can create potential liability for the school.



Physicians/trainers/doctors must give thorough exams  before allowing an athlete to return to play.

Team physicians/trainers/doctors must alert coaches  about the ability of player to return to play, and ensure that players that have not been cleared do not return.

Team physicians/trainers/doctors must be active in  monitoring the game/practice for players’ potential head injuries.

Caution should guide any decision about whether to  allow an athlete to resume participation.

If there is any doubt about the readiness of an athlete to  return to play, it is in the best interest of the athlete, coach, physician, and trainer to hold the athlete out.



DIRECTORS Most states require individual schools participating in  inter-scholastic sports to create a concussion policy.

When drafting a concussion provision it is essential to  understand the applicable standard and the rules that apply to you.

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