Implementing US state concussion laws is a challenge for many high schools

A team of researchers from Nationwide Children’s Hospital (OH, USA) discovered that when enforcing US state concussion laws high schools face many challenges.

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In the US, all 50 states introduced concussion laws between 2009–2014 to reduce the effects of concussion. Whilst the laws vary from state to state, all state laws address three main factors: 

  • Concussion education 
  • Removal of players after suspected concussion
  • Return-to-play requirements 

A team of researchers from the Center of Injury Research and Policy in the Abigail Wexner Research Institute at Nationwide Children’s Hospital (OH, USA) investigated the challenges high schools face when implementing state concussion laws. 

In the study published in Journal of Adolescent Health, the researchers conducted 64 semi-structured phone interviews in which athletic trainers noted that the educational concussion materials available often included complex medical language and did not require active learning. 

Additionally, the athletic trainers highlighted that there is a lack of commitment towards the law requirements from both coaches and parent, as they may not understand the potential severity of these injuries. Therefore, scheduling time for such training and compliance with school concussion policy is not made a priority. 

        Our hope is that school administrators, athletic directors, and athletic trainers can use these findings to identify implementation barriers in their own schools," commented Ginger Yang (Nationwide Children’s Hospital), senior author of the study. "These findings can help high schools structure their school's policies to maximize the safety of student athletes and shed light on necessary updates and revisions to current state-level concussion laws."

Barriers around implementing laws related to removal of players after a suspected concussion included athletes’ unwillingness to disclose concussion symptoms, as well as resistance from both coaches and parents. This may be a result of sports culture and an ‘old school’ mentality that encourages players to ‘toughen up’ after an injury.

        It is imperative that parents, athletes and coaches understand and follow their school's concussion policy. It's better to sit out for a game than to get injured worse and miss the rest of the season," explained Sean Rose, Pediatric Sports Neurologist at Nationwide Children's Hospital. "Athletic directors, school administrators and athletic trainers can help create an environment that focuses on the safety of the kids and encourages the disclosure of concussion symptoms and immediate removal from play following an actual or suspected concussion."  

With regards to return-to-play centered laws, challenges included the high costs of medical treatment and lack of clarity as to which medical professions should provide return-to-play clearance. Being treated by a medical professional who has up-to-date, concussion-specific training is desirable, however, access to such professionals is limited. 

Policy makers can use the findings from this study to update and clarify current laws, especially for athletes who face sociocultural or socioeconomical barriers. Understanding the implementation barriers high schools are facing is essential when trying to execute successful application of the state concussion laws. Future research is required to discover strategies that will reduce these barriers.

Sources: Coxe KA, Sullivan L, Newton A and Yang J.Barriers to the Implementation of State Concussion Laws Within High Schools. J. Adolesc. Health. doi:10.1016/j.jadohealth.2019.08.016 (2019) (Epub ahead of print);

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Kimberley Ndungu

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