State setting new rules on concussions

Young athletes will need doctor’s OK before return to field

Bruin Nathan Horton’s head was immobilized when he was removed from the ice on Monday. Bruin Nathan Horton’s head was immobilized when he was removed from the ice on Monday. (Adam Hunger/Reuters)
By David Abel
Globe Staff / June 8, 2011

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State health authorities are expected to approve regulations today that seek to reduce head injuries in adolescent athletes, a risk underscored this week when Bruins winger Nathan Horton suffered a severe concussion after a brutal hit during the Stanley Cup finals.

The rules mandate that students sustaining head injuries or suspected concussions during extracurricular sports activities be removed immediately from practice or competition and be barred from returning to practice or play the same day.

The regulations require schools to inform parents promptly and call for students to have medical clearance before resuming athletic activity. A “graduated reentry plan’’ must be developed before students diagnosed with concussions can return to the classroom or the field.

The regulations would apply to all extracurricular sports for public middle and high schools and to members of the Massachusetts Interscholastic Athletic Association, but would not cover community teams, such as Little League or Pop Warner.

In Massachusetts, 18 percent of students reported experiencing a head injury serious enough to cause unconsciousness, memory problems, blurry vision, headaches, or nausea in the previous 12 months, according to a survey of middle and high school students conducted by the state Department of Public Health. About 200,000 Massachusetts high school students participate in extracurricular sports.

“These regulations offer an opportunity for the Commonwealth to make sure everyone involved in youth sports is on the same page regarding head injuries and concussions,’’ Dr. Lauren Smith, medical director of the state health agency, said in a telephone interview. “These regulations really ensure that everyone understands that, when in doubt, sit them out. If there’s any doubt that there’s a head injury, the students must be removed from play and evaluated.’’

That evaluation and the clearance needed to return to play can come from a physician alone or from a certified athletic trainer or nurse-practitioner who has consulted with a doctor. It also could come from a neuropsychologist who has collaborated with the student’s physician. Those providing clearance must complete training on concussions by 2013.

State officials are scheduled to present the regulations this morning to the Public Health Council, an appointed panel that includes doctors, consumer advocates, and professors. The rules were proposed in January and underwent a monthslong public comment period, in which several changes were made.

The changes include providing schools more flexibility in documenting required training; the exclusion of minor cuts to the scalp and face from the definition of a head injury; and a requirement that schools only need to inform state officials by January 2012 that they have applied the regulations, rather than submitting precise policies.

The regulations come a year after the Legislature approved a law requiring head-injury safety training programs for anyone involved in extracurricular athletic activities at a Massachusetts Interscholastic Athletic Association school.

Nationwide, 135,000 children from 5 to 18 years old are treated each year for traumatic brain injuries related to sports and recreation, including concussions, according to the Department of Public Health.

Massachusetts is one of at least 17 states that have adopted laws to protect student athletes from concussions and the potentially deadly complications of multiple head injuries, said Dr. Robert Cantu of the Boston University School of Medicine, one of the nation’s leading specialists in sports-related trauma.

The number of states with such laws has nearly doubled since January, in part because the National Football League has helped finance a push for such laws around the country, he said.

“The most important thing is that there’s education for the athlete, parents, and coaches, so they understand the risks of playing with concussion symptoms, which are highly unacceptable,’’ Cantu said. “What’s really exciting to me is that although there are 17 states that have passed this legislation, Massachusetts is the first to put teeth into the law by explaining what the qualifications need to be of the medical personnel who decide on whether a student can return to play.’’

David Abel can be reached at