Student-Athletes & Concussions: Getting Your Head OUT of the Game

1. Student-Athletes & Concussions: Getting Your Head OUT of the Game VSBA School Law Conference – 2011 Joel S. Brenner, MD, MPH Children's Hospital of The King's Daughters Wendell C. Roberts, Esquire Staff Attorney, VSBA

2. Student-Athlete ConcussionsA local, state, and national issue • As of May 2011, 17 states have passed laws protecting student-athletes from concussions. • In addition, similar legislation is pending in 23 other states.

3. On January 26, 2011, 11 members of Congress introduced H.R. 469 – “Protecting Student Athletes from Concussions Act of 2011” If passed, the legislation would require states to enact regulations that would require local school division to develop and implement concussion safety plans.

4. Recent Research Findings • H.R. 469 cites research reporting that between the 2005-2008 school years, over 400,000 students sustained concussions while participating in high school athletics. • A national study published in Pediatrics Journal reported that emergency room visits for suspected concussions more than tripled among students aged 14-19 in the decade between 1997 and 2007; and doubled for younger student aged 8-13 over the same time period. • The Center for Injury Research and Policy found that last year 40% of high school concussion sufferers returned to play too quickly (as per AAN “return-to-play” guidelines); and • During the 2007-2008 season alone, 1 in 6 football players who sustained a concussion and lost consciousness (15.8 %) returned to play the same day.

5. What does all the research mean? • Our culture has changed in that we are recognizing concussions, we are seeking treatment. • Our culture has not changed with regard to the “return-to-play” decision. Our kids are coming back to the play way too soon after being treated for the injury.

6. Concussions Remain in the News

7. Virginia Law – S.B. 652 Sen. Ralph S. Northam – (6th District, Pediatric Neurologist) 2010 General Assembly The law directs the BOE to develop and distribute concussion management guidelines to local school divisions. In accordance with the BOE’s guidelines, each local school division shall develop policies and procedures regarding the identification and handling of suspected concussions in student-athletes.

8. VA DOE – Developed Guidelines (BOE adopted on January 13, 2011) DOE staff worked with numerous stakeholder groups Virginia High School League, the Department of Health, the Virginia Athletic Trainers Association, representatives of the Children’s Hospital of The King’s Daughters and the Children’s National Medical Center, the Brain Injury Association of Virginia, the American Academy of Pediatrics, the Virginia College of Emergency Physicians and other interested stakeholders.

9. Five “Pillars” of the DOE Guidelines Training of Coaches/Adults Educate Parent/Students Removal From Play Return To Play Record Keeping

10. Training of Coaches and Adults • Annual training of all Coaches, Staff, and Volunteers who serve in and coaching capacity. • Recognition of the student-athlete that may have sustained a concussion. • Extracurricular activities; games, practices, tryouts, and after-school intramurals.

11. RESOURCESOnline Training www.nfhs.org www.cdc.gov

12. Providing information to the Student/Athlete and Parent • Provide information annually on the risks of sustaining concussions • & • The risks of further injury if returnedto play before a concussion is fully healed.

13. RESOURCES www.cdc.gov/ConcussionsInYouthSports

14. Develop a Process for Conducting Sideline Assessments • Decide what sideline assessment instrument is going to be used; and • Decide who is going to conduct the assessment. • Popular Assessment Tools: • SCAT2: Sports Concussion Assessment Tool 2 • BESS: Balance Error Scoring System “If in doubt, sit them out.”

15. RESOURCES Sideline Assessment Training Collaborative effort by the VHSL Sports Medicine Committee, Brain Injury Association of Virginia, Virginia Athletic Trainers Association to provide training to local school divisions. Sideline Assessment Forms • SCAT2 – www.sportsconcussions.com • BESS - www.knowconcussion.org • Google

16. The“Return-To-Play” Decision • The Virginia DOE guidelines stated that a student-athlete should not be allowed to return to play until - “the student receives a written medical release from a licensed health care provider.” • VSBA model policy recommends clarification that written medical release should come from the student-athlete’s licensed health care provider. • VSBA model policy recommends that the written medical release contain certification that the licensed health care provider that (i) they are aware of the current medical guidance on concussion evaluation and management; (ii) the student-athlete no longer exhibits signs symptoms or behaviors consistent with a concussion; and (iii) that the student-athlete has successfully completed a progressive return to sports participation program.

17. Record Keeping • Creation of a Concussion Management Team – Appointed by Superintendent, division wide and broad membership to coordinate training and information efforts. • Communicate recordkeeping school based recordkeeping requirements with regard to training of coaches, staff, and volunteers and efforts to inform parents. • Track the care and treatment of all students-athletes removed from play due to suspected concussions.

18. QUESTIONS???

19. THANK YOU!!! Joel S. Brenner, MD, MPH Children's Hospital of The King's Daughters & Wendell Roberts, Staff AttorneyVirginia School Boards Assn. wroberts@vsba.org (434) 295-8722