By Mark B. Seiger, Esq. and Charles F. Gfeller, Esq.
Traumatic brain injuries (TBIs) among young athletes have garnered increased attention recently, due in large part to a growing awareness in the medical and athletic communities regarding the prevalence and potentially devastating effects of head injuries in youth sports. This increased knowledge and awareness has resulted in an ever-changing landscape for schools, athletic programs and sports leagues as it relates to the risk of head injuries and the management of that risk. Consequently, in order to minimize the severity and occurrence of head injuries, and the potential exposure for same, schools, leagues, coaches, athletes, and parents must consider a number of factors. Following is a brief overview of the current science regarding the potential short-term and long-term effects of traumatic brain injuries, a brief discussion of the numerous “concussion laws” recently enacted across the country, and recommendations for how schools, athletic programs and sports leagues can best minimize and manage the risks associated with head injuries in competitive youth sports.
Concussions & Second Injury Syndrome
Concussions are the most common type of TBI among athletes. Young children and teens are more likely to get a concussion and take longer to recover than adults. Even so-called “mild concussions” are complex brain injuries, the severity of which may not be fully known for hours, even days, after an injury occurs. Repeated mild TBIs occurring over an extended period of time – months, years – can result in cumulative neurological and cognitive deficits, such as the debilitating brain disease, chronic traumatic encephalopathy, which has been identified in the autopsied brains of fifty former athletes, including 14 former National Football League players and at least one of the three former National Hockey League ‘enforcers’ who died unexpectedly during the summer of 2011. Repeated mild TBIs occurring within a short period of time – hours, days, weeks – can be catastrophic or fatal. Second impact syndrome, or SIS, occurs when an athlete returns to play too soon after suffering an initial concussion. The athlete then sustains a second injury before the brain has healed from the first injury. Many times this occurs because the athlete has returned to play before his or her first injury symptoms fully resolve. Coaches, parents and athletes do not realize that some concussions take days, weeks and even months to heal. The second injury may only be a minor blow to the head or even a hit to the chest or back that causes the brain to rebound inside the skull. Because the brain is more susceptible to injury after an initial brain injury, it only takes a minimal force to cause irreversible damage. Second impact syndrome has a high fatality rate in young athletes.
Increased Awareness and Scrutiny
As a result of the increased knowledge and awareness of the potentially devastating effects of TBIs, the medical community, and more recently, the athletic community, provides specific recommendations for how a young athlete suffering a head injury should be evaluated, and when the athlete may return to play. Many athletic organizations and governing bodies require athletes suspected of suffering a head injury to immediately sit out from play for at least the remainder of that day, and to obtain medical clearance before returning to play. Many schools and sports programs have also implemented the Center for Disease Control’s Heads Up: Concussion In High School Sports initiative to educate coaches, parents and athletes. Some high school athletic associations have taken the additional step of requiring their participating high schools to develop concussion management plans which set forth a comprehensive protocol for determining when an athlete is ready to return, including a step-by-step assessment process and a gradual return to competitive play.
“Concussion” Laws are Rapidly Evolving Throughout the United States
While sports like football and hockey seem to get the most attention when it comes to concussions, other sports are not isolated from the concussion problem. Indeed, schools, athletic programs and sports leagues involved with all sports, including soccer, softball, baseball, lacrosse, field hockey, skiing, etc., must be aware of the problem and, in particular, the laws related to the management of concussions in youth athletes. As of this writing, thirty-one states have enacted youth sports concussion-related laws. The remaining states are considering new concussion laws or revisions to their existing laws. Most of the enacted laws contain return-to-play provisions requiring athletes with signs or symptoms of concussion to obtain a doctor’s authorization before playing again. Some of the statutes also include concussion training requirements for coaches; others require schools to craft and implement guidelines for dealing with concussions and for educating parents and athletes. The scope of each statute varies – some only address athletic programs affiliated with schools, while others pertain to all organized youth sports in a given state. For example, in March 2011, Colorado signed into law one of the most sweeping concussion-related laws in the country, requiring coaches of all youth organized sports to receive free online training in how to identify concussion symptoms in young athletes. The law also requires coaches who suspect a player has sustained a head injury to remove the athlete from play, and the injured athlete must obtain medical clearance before returning to play.
What Can Be Done to Manage and Fully Reduce the Risks Faced by Youth Athletes?
Although the risk of sustaining a head injury cannot be fully eliminated from sports, there are a number of steps that athletes, coaches, and parents can take to reduce the severity and occurrence of TBIs in youth athletics. These steps also serve to protect athletic hosts, like schools or youth sports leagues, from potential exposure to lawsuits. TBIs among young athletes are a serious public health issue that can only be mitigated if education, awareness and preparedness are improved across the board – among school administrators, athletic program and sports league managers, coaches, trainers, athletes, parents, and even teachers and classmates.
i. Know the Law
So, what can a school, athletic program or sports league do to protect itself and its young athletes? First, know the laws of your state. The scope of the enacted concussion statutes varies greatly, with some statutes applicable to only high school athletics, while others apply to all youth athletics in a given state. In addition, even if a state’s concussion law does not necessarily apply to your school or program, you should implement the portions of other states’ laws most likely to be enacted in your state, and most likely to affect the health of your young athletes (e.g., “return to play” provisions and concussion education programs).
ii. Establish a Comprehensive Protocol
Establish a comprehensive head injury protocol for your school or sports program, which includes on-field medical personnel at all games, training of your coaches and teachers in concussion symptom recognition, and providing education and training for parents and youth athletes. As part of this protocol, consider implementing baseline testing prior to the start of a particular athletic season. Baseline testing measures cognitive function prior to athletic participation. In the event that an athlete who has been baseline tested suffers a TBI, treating physicians are able to compare the post-injury cognitive function with the pre-injury function, in order to determine whether there has been any loss of cognitive function or ability, and to gauge whether the brain has sufficiently healed to permit returning to play. While it may not always be feasible to conduct baseline testing at all levels of competition, athletic programs at the higher levels of competition, such as high schools, should seriously consider including baseline testing as part of their protocol – many programs already do.
iii. Educate Athletes and Their Parents
Every sport carries risk. Before each athletic season, hold a team and parents meeting. Discuss the risks of participation; provide training in concussion recognition, and have the players and parents sign an acknowledgment that they have received the education and training.
iv. Utilize the Best Head Protection Available and Be Conservative – Winning is Not Everything
Keep abreast of the current science regarding protective headgear and make sure your athletes’ helmets comply with the latest industry recommendations. Finally, when in doubt about whether a law or recommendation applies to your school or program, err on the side of caution and comply. Any decision a program makes not to implement a widely recommended protocol or return-to-play policy may come back to haunt it. Whether an incident involves the star quarterback or a third-string player, everyone’s health and well-being must be treated equally.
Attorneys Mark B. Seiger and Charles F. Gfeller are partners with the law firm of Seiger Gfeller Laurie LLP. They provide risk management and litigation services for schools and various sports and recreation programs. They may be reached at: mseiger@sgllawgroup.com or cgfeller@sgllawgroup.com, or visit www.sgllawgroup.com.
