By Nikki Wilson and Robert L. Clayton
“When in doubt sit them out.” Although it is a simple motto, the NCAA has reiterated its stance on the safety of student-athletes when it adopted a new policy requiring all NCAA member institutions to enact a Concussion Management Plan to be in place for the 2010-11 school year. This policy is a culmination of the NCAA’s efforts to determine the appropriate care and treatment for its student-athletes’ injuries. It began in December when the Executive Committee encouraged each member-institution to develop protocols for handling concussions under the direction of a physician. Thereafter, on April 9, 2009 the NCAA held a “Concussion in Sport Collegiate Medical Summit” and invited subject experts in neurology, neuropsychology, sports medicine, as well as team physicians and athletic trainers.
Although the NCAA has issued the policy across all three Divisions, it is unclear how it intends to enforce the new policy. Clearly, the policy requires each institution to work hand in hand with its athletic training staff and medical providers who can make the best decision for the student-athletes’ health. Moreover, the policy removes the decision making responsibility from the coach to undermine any potential bias to return the athlete to competition to the detriment of the athletes’ health. The policy also requires the student-athletes to accept responsibility for reporting injuries to avoid athletes who fail to report problems in order to remain in competition.
On April 29, 2010, Debra Runkle, Chair of the NCAA’s Committee on Competitive Safeguards and Medical Aspects of Sports (CSMAS), issued a memorandum to all NCAA Head Athletic Trainers outlining the new policy. Specifically, the policy reads as follows:
Institutions shall have a concussion management plan on file such that a student-athlete who exhibits signs, symptoms or behaviors consistent with a concussion shall be removed from practice or competition and evaluated by an athletics healthcare provider with experience in the evaluation and management of concussion. Student-athletes diagnosed with a concussion shall not return to activity for the remainder of that day. Medical clearance shall be determined by the team physician or their designee according to the concussion management plan.
In addition, student-athletes must sign a statement in which they accept the responsibility for reporting their injuries and illnesses to the institutional medical staff, including signs and symptoms of concussions. During the review and signing process student-athletes should be presented with educational material on concussions.
In addition, the CSMAS recommended “Best Practices” each member-institution should consider in developing their Concussion Management Plan. While these “Best Practices” are couched as “recommendations,” it is clear the NCAA intends them to be a strict guideline in developing a Concussion Management Plan. Below is a sampling of the “Recommended Best Practices”:
1. Institutions shall require student-athletes to sign a statement in which student-athletes accept the responsibility for reporting their injuries and illnesses to the institutional medical staff, including signs and symptoms of concussions.
2. Institutions should have on file and annually update an emergency action plan for each athletics venue to respond to student-athlete catastrophic injuries and illnesses. All athletics healthcare providers and coaches should review and practice the plan at least annually.
4. Athletics healthcare providers should be empowered to have the unchallengeable authority to determine management and return-to-play of any ill or injured student-athlete, as he or she deems appropriate.
5. Institutions should have on file a written team physician-directed concussion management plan that specifically outlines the roles of athletics healthcare staff (e.g., physician, certified athletic trainer, nurse practitioner, physician assistant, neuropsychologist). In addition, the following components have been specifically identified for the collegiate environment:
a. Institutions should ensure coaches have acknowledged they understand the concussion management plan, their role within the plan and that they received education about concussions.
b. Athletics healthcare providers should practice within the standards as established for their professional practice (e.g., physician, certified athletic trainer, nurse practitioner, physician assistant, neurologist, neuropsychologist).
c. Institutions should record a baseline assessment for each student-athlete prior to the first practice in the sports of baseball, basketball, diving, equestrian, field hockey, football, gymnastics, ice hockey, lacrosse, pole vaulting, rugby, soccer, softball, water polo, and wrestling, at a minimum. The same baseline assessment tools should be used post-injury at appropriate time intervals.
d. When a student-athlete shows any signs, symptoms or behaviors consistent with a concussion, the athlete shall be removed from practice or competition and evaluated by an athletics healthcare provider with experience in the evaluation and management of concussion.
e. A student-athlete diagnosed with a concussion shall be withheld from the competition or practice and not return to activity for the remainder of that day.
f. The student-athlete should receive serial monitoring for deterioration. Athletes should be provided with written instructions upon discharge; preferably with a roommate, guardian, or someone that can follow the instructions.
g. The student-athlete should be evaluated by a team physician as outlined within the concussion management plan. Once asymptomatic and post-exertion assessments are within normal baseline limits, return to play shall follow a medically supervised stepwise process.
h. Final authority for return-to-play shall reside with the team physician or the physician’s designee.
The NCAA intends to conduct a webinar for medical staff this summer. However, at this point, there is not a clear indication how the NCAA will monitor the creation and implementation of this new policy. Each member-institution must take care to encompass the above best practices within their Concussion Management Plan, but also must individualize its plan to take into account resources, medical staffing, and the safety of student athletes. As the NCAA continues to reiterate, “It’s better they miss one game than the whole season.”
Nikki Wilson, Esquire, is a member of the Jackson Lewis Sports Compliance Group in the Orange County office.
Robert L. Clayton, Esquire, is the Chair of the Jackson Lewis Sports Compliance Group in the Washington, D.C. Region office.
