The Regulatory Review

A thumbs up game for youth concussion regulation | Regulatory Review

Experts explore the impact of concussion legislation on teen health and education.

Should parents and guardians let their children participate in youth sports? Up to 1.9 million children suffer a sports-related concussion every year, posing long-term risks to young, developing brains. Meanwhile, Will Smith’s performance in Concussion and a series of Pop Warner youth football lawsuits have put youth concussion prevention in the spotlight.

Over the past decade, public health experts, advocates and policymakers have debated the effectiveness of concussion legislation and considered potential reforms to address the ongoing health effects of concussions in young people.

The Centers for Disease Control and Prevention launched a series of educational initiatives in 2003 called HEADS UP aimed at raising awareness of concussion prevention, recognition, and response. The lack of federal youth concussion legislation, however, has led many states to adopt their own regulatory regimes.

Washington passed the first state concussion law in 2009. Named after Zackery Lystedt, who suffered a catastrophic brain injury after hitting his head during a college football game, the law required that young athletes suspected of having suffered a concussion receive approval from an accredited health center. supplier before returning to play. The law also required schools to implement educational programs to educate coaches, parents and student-athletes about the nature and risk of concussions.

Between 2009 and 2014, all 50 states enacted youth concussion legislation, which has been shown to increase concussion reporting, improve coach education, and reduce rates of recurrent concussions. Some states have added stricter requirements regarding minimum downtime before resuming play. For example, New York prohibits return to play until student-athletes are symptom-free for at least 24 hours, while California requires a minimum of seven days of gradual return to play under the supervision of a licensed healthcare provider. Fourteen states not only restrict returning to play, but also restricting returning to class.

Despite current legislation, concussions and sports disputes persist. State legislators remain concerned about the effectiveness of enforcement strategies, education gaps and the extent of coverage. International experts in traumatic brain injury research have also called for reform in youth sports to prevent repetitive impacts to the head before the age of 14. Above all, parents fear the potential consequences of allowing their children to play football or other contact sports.

At this week’s Saturday seminar, academics debate whether current concussion legislation provides sufficient safeguards for youth sports.

  • Although all US state legislatures have passed concussion legislation aimed at youth sports, the effectiveness of these laws and the best ways to implement them remain unclear, says Francis X. Shen of Harvard Medical School. Center for Bioethics in an article published in the Duquesne Law Review. Shen found that youth concussion laws have been “widely accepted,” but that third parties may be reluctant to specific concussion mandates when those protocols interfere with athletic aspirations or individual medical relationships. Nonetheless, Shen concludes that these laws have increased the recognition and accurate reporting of concussions. Thus, Shen argues, regulators should increase the dissemination of concussion information to provide student athletes and their parents with better risk assessment.
  • In an article published in the Journal of Business and Technology Law, Kerri McGowan Lowrey of the University of Maryland Francis King Carey School of Law studies the current sphere of statewide legislation regarding concussion in youth sports. According to Lowrey, many states initially adopted frameworks similar to Washington State’s Lystedt Act, but the actual applications of these laws differed significantly from state to state. For example, Washington law requires concussion risk education, but what constitutes “education” varies, and therefore may fluctuate in effectiveness. Recently, states have begun to clarify and strengthen their statutes in accordance with medical guidelines. Lowrey also notes that certain regulations can improve the safety of recreational sports overall by mandating the proper use of sports equipment, such as helmets and mouth guards.
  • In an article published in the Yale Journal of Health Policy, Law, and Ethics, Senior Health Care Consultant Sydney Diekmann and several co-authors argue that mandatory concussion education for coaches and student-athletes will not produce beneficial health outcomes. The Diekmann team explains that while interventions based on state education can produce short-term increases in relevant knowledge, this knowledge does not lead to behavioral changes that successfully reduce concussion risk. Thus, the Diekmann team concludes that concussion interventions that focus on primary prevention and changes in concussion reporting will be more effective.
  • In an article published in the Catholic University Law Review, Tracey B. Carter of Belmont University College of Law examines if and how state youth concussion laws are driving cultural change in youth and professional sports. Although individuals have turned to the courts to deal with concussions in recent years, Carter posits that litigation is not the most effective remedy. Carter argues that states should continually update their concussion laws in light of new research, implementation issues and best practices. Carter also argues that youth sports governing bodies, such as Pop Warner, can play an important role in re-examining local safety practices and protocols.
  • Variation in concussion legislation in the United States shows gaps in the protection of young people participating in sports, say Kelly L. Potteiger and several co-authors in an article published in the The Internet Journal of Allied Health Sciences and Practices. Although all 50 states have legislation regarding sports concussions, barely a third of the laws encompass public, private and youth sports organizations. Similarly, other laws only protect students who fall within a certain age range. Team Potteiger argues that concussion legislation should include all children, regardless of age or involvement in sports, to ensure consistency of rights. Additionally, health care providers should play a greater role in developing such policies, especially those focused on concussion education.
  • In an article published in Sport Health, Andrew W. Albano of the University of South Carolina Greenville School of Medicine and several co-authors provide a forensic analysis of concussion care. An athletic trainer has a duty to act as a doctor when undertaking a concussion evaluation or risk a gross negligence charge, Albano’s team claims. Additionally, if a licensed healthcare provider is unavailable to assess a suspected concussion, the student-athlete cannot return to play under current concussion legislation. Albano and his co-authors, however, identify various barriers to the effective implementation of these legal mandates, including parental cooperation and access to concussion management providers in rural and underserved areas.

The Saturday Seminar is a weekly feature that aims to put into written form the type of content that would be delivered in a live seminar involving regulatory experts. Every week, Regulatory Review publishes a brief overview of a selected regulatory topic and then summarizes recent research and academic writing on that topic.

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