Winning the Battle Massachusetts’ Sports Concussion Law and a new era of TBI Prevention Lewis Howe Executive Director The Safety Institute August 22, 2012

Why concussion laws are needed Sea change of thought: We now know Concussions are Traumatic Brain Injuries, not “dings” or “getting your bell rung” Chris Nowinski and Dr. Robert Cantu discovered and promoted link between repeat brain injuries and CTE. Founded Sports Legacy Institute in Nowinski’s book, “Head Games,” alerted the media to this public health problem. Initial state laws on managing sports concussions were enacted in Oregon and Texas. We drafted original MA legislation in Filed by then-Sen. Steve Baddour. We were sixth state to enact such a law in July As of July 2012, 39 states plus D.C. have enacted sports concussion laws. MA was first to require doctors to receive training in managing head injuries in order to sign off kids to return to play. (takes effect 2013)

Dream Team of Experts MA “Return to Play Advisory Committee” Alan Ashare, Mass. Medical Society Alex Taylor, Boston Children’s Hospital Anne Sheetz, School Nurse coordinator, MDPH Greg Parkinson, AAP, MA Chapter Janet Kent, South Shore Hospital Joe Scott, Southcoast Lauren Smith, DPH Medical Director Neal McGrath, Sportsconcussion.net Nikolaus Kashey, Bay State Health Paul Rosman, BMC Robert Cantu, Emerson Hospital/SLI Robert Harney, Hallmark Health Sharon Hoover, Emerson Hospital Bill Meehan, Childrens Hospital

Governing Regulations RTP Panel wrote strongest, most detailed regulations to date. “Any student who during a practice or competition sustains a head injury or suspected concussion” shall be removed from the practice or competition and may not return to the practice or competition that day. Triggers several steps for medical clearance known as “graduated reentry”

Requirements for Parents and Students Must take CDC’s on-line education course on sports concussions at beginning of each school year. Sign and submit pre-participation form that provides school with student’s medical history. If child is injured during the season, parent must complete Report of Head Injury Form and submit to appropriate school personnel.

Requirements for Athletic Directors Complete the annual on-line training Participate in the development and review of school concussion policies. All schools must submit comprehensive policies to state Dept. of Public Health Ensure that all staff, parents, volunteers coaches and students complete training as mandated by law. Manage all pre-participation and head injury incident forms, unless school policy designates other person(s) to do so. Report annual concussion statistics to MDPH. Ensure that athletes are prohibited from engaging in any unreasonably dangerous athletic technique that endangers the health or safety of an athlete, including using a helmet or other sports equipment as a weapon (taken from TX law).

Requirements for Coaches Completing on-line annual training Reviewing pre-participation forms so as to identify those athletes who are at greater risk for head injuries. Completing a Report of Head Injury form upon identifying a student with a suspected concussion that occurs during practice or competition. Reviewing Report of Head Injury forms submitted by parents who report a head injury during sports season that occur outside of organized athletic activity. Transmitting forms PROMPTLY to school nurse for timely and accurate updates to students’ health records. Teaching safe play techniques, discouraging dangerous play such as helmet to helmet hits. Identifying athletes with head injuries or suspected concussions that occur in practice or competition and removing them from play.

Role of Certified Athletic Trainers Complete on-line training and participate in development and review of school head injury policies. Review pre-participation and Report of Head Injury forms to identify students at greater risk. Identify athletes with head injuries or suspected concussions occurring in practice or competition and removing them from play Participating in, if available the graduated re-entry planning and implementation for students who have been diagnosed with a concussion.

Role of School Nurses All requirements of other partners, plus: Monitoring recuperating students with head injuries and collaborating with teachers to ensure that the graduated reentry plan for return to full academic and extracurricular athletic activities as required by the law are being followed. Providing educational materials on TBI/concussions to teachers, staff and students.

What about equipment? According to the National Operating Committee on Standards for Athletic Equipment (NOCSAE): “Currently there is no definitive scientific research linking mouth guards, head bands, supplements or other specialty products to a reduction in concussion risk or severity.”–

What to do if a child is hurt If you are at an MIAA-sanctioned game or practice, and see a participant child suffer a head injury: Make sure the child is removed from play immediately by coach, official, or certified athletic trainer on site. If it is your child who is injured, take your child for medical evaluation immediately, report to school or athletic team; complete Report of Head Injury form. If you believe rules are not being followed, do not be afraid to speak up!

Is it working? MDPH--in terms of ED treatment for TBI in school age children, the latest data we have ends 9/30/11 so we are a year away of any ED data assessing impact. Only about ten percent of school districts have submitted data to MDPH.-Boston Globe, Aug 2012 MIAA opposed the bill when filed, has been slow to advocate for it.

What next? More studies of effects of TBI/concussions on human brain being released every year. Our understanding of risks of CTE has grown exponentially in last five years More districts requiring IMPACT and other tests. Additional youth leagues enacting regulations around concussion management. Lawsuits against National Football League bear watching, may lead to further regulations. Continue educating parents and players on what we know — “when in doubt, sit them out.”

Additional resources Sports Legacy Institute— Sportsconcussions.org, Washington State CDC’s Heads Up campaign, Brain Injury Association of MA Athletic Trainers of Massachusetts

Play Safe, Stay Safe!