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Revising the Game Plan: Primary Prevention, Early Detection, and the Future of Concussion Laws

posted on Mon, Jul 21 2014 2:57 pm by Kerri McGowan Lowrey

In the past few years, one couldn’t shake a hockey stick without hitting a sports concussion story. Even the recent World Cup had its own concussion controversy. Uruguay defender Álvaro Pereira was knocked unconscious after taking a knee to the head during a match with England. After spending several moments lying flat on the field, he could be seen arguing with team leaders to allow him to return to the game, which (shockingly), he did. In the United States and abroad, much attention has been paid to changing the culture of sports, particularly youth sports, away from a gladiator mentality to one centered on player safety.

To date, every state and the District of Columbia has passed a law seeking to prevent the catastrophic damage and even death that can occur from sustaining a subsequent concussion before the brain has adequately healed from the first. Now that many of these laws have been in effect for a few years, legislatures are revisiting them and making changes according to developments in the field. At least 17 states have made substantive changes to their laws since original enactment, and more are likely to follow suit as best practices and results of policy evaluation emerge. These changes fall into three main categories:

  1. Expanding coverage to include, for example, cheerleading, private schools, or youth recreational sports;
  2. Tightening existing requirements (e.g., return-to-play, education and training); and
  3. Primary prevention (i.e., provisions designed to prevent concussions from occurring in the first place) and improved early detection.

Few states sought to incorporate primary prevention measures into their original concussion laws. One exception, Massachusetts, prohibits coaches, trainers, and others from encouraging or allowing a student athlete to use sports equipment as a weapon or to engage in sports techniques that are unreasonably dangerous, such as helmet-to-helmet hits. More states are considering changes to their laws that would advance primary prevention approaches to the problem. For example, Connecticut considered limiting full-contact practices to 90 minutes per week. New Jersey’s new sports safety law requires a physical examination and concussion history to be taken prior to athletic activity. Laws for all 50 states and the District of Columbia are summarized here.  

The business world is taking notice of the laws’ requirements. Research and development firms are busy finding ways of preventing concussion and/or improving diagnosis or return-to-play decision-making. One example is the use of helmet sensors and similar impact-sensor technologies that provide real-time monitoring of head impact exposure to identify high-risk impacts and, at least in theory, alert sideline personnel that a concussion assessment is warranted.

Maryland introduced a bill during the 2014 legislative session that would have established a pilot program to test the use of helmet sensors in one high school football team in each county. The state’s Athletic Trainers Association and Nurses Association, among others, opposed the bill due to concerns about false negatives, a false sense of security in an untested diagnostic measure, concern about compromising helmet standards, and the sense that the bill “put[s] the equipment ahead of the science.” One thing is certain: the race for technologies to address the concussion problem has just begun, and the law will need to keep pace.

A session will be devoted to exploring the use of law in prevention of traumatic brain injury (TBI) in youth sports at the 2014 National Public Health Law Conference, October 16-17 in Atlanta, Georgia. Presenters will discuss implementation, litigation, impact on disparities, and public health implications of sports law. Hope you can join us in Atlanta for the discussion.

This post was prepared by Kerri McGowan Lowrey, Deputy Director, the Network for Public Health Law — Eastern Region at the University of Maryland Francis King Carey School of Law. 

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state. The views expressed in this post do not represent those of the Robert Wood Johnson Foundation.

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