Rules offered to curb youth head injuries

“We’re increasingly aware that there is no such thing as a mild concussion that you just shake off and ignore.” — Dr. Lauren Smith, Medical director, Mass. Department of Public Health. “We’re increasingly aware that there is no such thing as a mild concussion that you just shake off and ignore.” — Dr. Lauren Smith, Medical director, Mass. Department of Public Health.
By Stephen Smith
Globe Staff / January 24, 2011

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Massachusetts health authorities are expected to propose today stringent regulations aimed at reducing head injuries in adolescent athletes — and assuring that injured players don’t return to the field until their brains have recovered.

The rules give form to emergency legislation enacted last summer amid burgeoning concerns about the long-term consequences of concussions and a sports ethos that for decades celebrated athletes who proved their mettle by playing even when their heads throbbed and they felt woozy.

Parents and students in middle school and high school would be required under the rules to complete online training courses annually. Schools would have to maintain records on head injuries. Doctors would have to undergo additional training if inexperienced in assessing and manag ing concussions.

A survey of middle and high school students conducted by the state Department of Public Health found that 18 percent reported that during the previous year, they suffered a sports injury serious enough to spark unconsciousness, memory problems, blurred vision, headaches, or nausea. About 200,000 Massachusetts high school students participate in extracurricular sports.

“We’re increasingly aware that there is no such thing as a mild concussion that you just shake off and ignore,’’ said Dr. Lauren Smith, medical director of the Department of Public Health. “My very strong hope is that in Massachusetts, we will create an environment where student athletes are protected as much as possible from the adverse consequences of concussions.’’

This morning, state officials will present the regulations to the Public Health Council, whose blessing is required for passage. The council — an appointed panel of doctors, consumer advocates, and professors — usually follows the recommendations of Governor Deval Patrick’s administration, albeit with small tweaks. A vote is expected in late spring.

The concussion rules would apply to public middle and high schools as well as private schools that belong to the Massachusetts Interscholastic Athletic Association. That organization, as well as the Massachusetts Association of School Committees, expressed general support but cautioned that record keeping requirements could prove onerous for administrators already grappling with new rules governing bullying.

“This is Massachusetts, the regulation and punishment capital of the United States, so it would come as no surprise to anyone that there will be additional forms, additional steps, additional record keeping, and mandatory elements to the resolution of this problem,’’ said Glenn Koocher, executive director of the school committees alliance.

“However,’’ he added, “if it’s a question of more or less action to protect kids from head injury, we’re going to side with more action until we see how this works.’’

Massachusetts is one of nine states that have adopted laws designed to protect student athletes from concussions and the potentially lethal complications that can ensue from repeated head injuries, said one of the nation’s leading specialists in sports-related trauma, Dr. Robert Cantu of the Boston University School of Medicine.

The laws reflect the rising anxiety around concussions among both young athletes and professional stars. Research pioneered at BU with professional athletes has shown that repeated blows to the head can lead to a degenerative disease resulting in cognitive and behavior disorders and, ultimately, dementia.

While it is rare for high school athletes to die from head injuries, Cantu said, he encounters two to four such fatalities each year as medical director of a research center at the University of North Carolina that investigates catastrophic sports injuries. Those deaths, he said, illustrate the importance of making sure that clear guidelines exist about the assessment and treatment of head injuries in sports.

“The way we manage concussions in athletes is different than the way you manage them in people who are not in athletic pursuits, especially in sports where head trauma is a risk,’’ said Cantu, co-director of BU’s Center for the Study of Traumatic Encephalopathy. Young athletes who plunge back into school work or sports too soon — or, even worse, sustain a second blow — risk that they will set off a cascade of dying brain cells.

At Hingham High School, the hockey team several years ago took measures to assure that injured players received medical clearance before returning to the ice, said Ronald Driscoll, whose son Tim is one of the team captains.

“The days of sucking it up and going back on the ice or the field or any arena are long gone,’’ said Driscoll, who said his son has avoided head injuries playing hockey. “Obviously, they should be paying attention to any head injury, because you never know.’’

The law passed last year was intended to swiftly respond to concussion worries, but, in moving with such haste, lawmakers left coaches, parents, and players bewildered, said Concord-Carlisle Regional High School athletic director Barry Haley, president of the Massachusetts Interscholastic Athletic Association. It went into effect before state health authorities had time to draft the regulatory details that typically accompany such legislation.

Being unable to tell his members exactly what to do was unsettling, said Haley, adding that his organization has already championed several provisions to alleviate head injuries. “I want to follow the law, believe me,’’ he said.

The proposed new state regulations, health authorities said, aim to end confusion surrounding last year’s law.

At their core, the rules focus on education — trying to prevent concussions from happening in the first place — and making sure that if a head injury occurs, the response is swift and the treatment complete. State health regulators said the cost to schools of implementing the new rules should be minimal.

The rules require coaches, trainers, and team volunteers to teach athletes techniques designed to mitigate head injuries. Another part of the prevention strategy involves two free online training programs regarding head injuries. Parents and students will be expected to take a course and submit a certificate confirming completion. Families without computer access should be given printouts, Smith said, and a form to sign acknowledging they have read the material. Coaches, volunteers, and others involved with school sports would undergo training as well.

Student athletes who sustain head injuries should be pulled from games and practices immediately, the regulations stipulate, and parents must be notified. If a player suffers a concussion, a plan must be developed to gradually reintroduce the student to academics and athletics.

A written authorization from a medical professional would be required before students could resume sports. That permission could come from a physician or from certified athletic trainers or nurse practitioners who consult with a doctor.

The panel of state officials and outside specialists that drafted the regulations insisted that the medical professionals who provide clearance to injured athletes must have training in assessing and managing concussions no later than September 2013.

“What the advisory panel told us is they didn’t want a rubber stamp that would allow a kid just to jump back in without understanding what a concussion is and what the implications are,’’ Smith said.

Although the law passed last year gave the Department of Public Health authority to punish schools that don’t comply, the agency is not establishing penalties at this time, Smith said.

Haley lamented that the rules do not extend to leagues for younger children, such as Pop Warner. State health officials said they hope the middle school and high school regulations will inspire reforms throughout the ranks of youth athletics.

Stephen Smith can be reached at