There are few detractors when it comes to decreasing the risks of serious head injuries, so there wasn't much argument against the recent tightening of NFHS and NCAA concussion safety guidelines. Earlier this year, the NFHS tweaked its football guidelines to say that an athlete must be removed from play if he shows signs or symptoms of a concussion, and must be cleared by a healthcare professional before returning to play. The NCAA instituted a similar rule, starting in 2010-11, for all sports across all divisions, and will require athletes to sign a statement that they take responsibility for reporting any signs of concussions.
It also didn't prove difficult for legislators in Oregon and Washington to implement new laws aimed at keeping youth athletes out of action until return-to-play clearance is obtained from a medical professional. A handful of other states, including California, Idaho, and New Mexico, are close to approving similar legislation.
While the changes represent a positive step for athlete safety, they do come with some important questions. For example, who determines if an athlete has suffered a concussion? Who qualifies as a "healthcare professional" with the power to determine when a concussed athlete can return to play? And what if your school can't afford to hire an athletic trainer or contract a physician to be on the sidelines?
"Unfortunately, these questions are not easily answered," says Michael Koester, Chair of the NFHS Sports Medicine Advisory Committee and Oregon School Activities Association Medical Aspects of Sports Committee. "There's a lot of gray area when it comes to concussions, and it's understandable that the changes seemingly add to the burden for administrators. But instead of looking at it like one more thing they have to worry about, athletic directors need to understand that this is a safety issue."
The biggest questions most administrators have center on exactly who qualifies as a healthcare professional and can approve a concussed athlete's return to play. The NCAA is requiring each institution to have a concussion management plan that spells this out. At the high school level, Koester says that the decision is being left up to individual schools, their districts, or conferences.
"Athletic trainers are definitely qualified to make these decisions," he says. "But others, like primary care physicians or nurse practitioners, are qualified as well.
"If your school doesn't have an athletic trainer on staff, you really need to find a healthcare professional in the community that the athletic program can have a relationship with," Koester continues. "It doesn't have to be a physician on the sideline at every game, but just somebody you can call or shoot an e-mail asking if they would evaluate an athlete who's had a concussion."
The NCAA rule change includes a provision that steps up the referee's role in concussion assessment, and has brought up other questions. In football and men's and women's soccer, "signs of a concussion" has been added to the list of instances in which a referee may stop the game clock. Barry Mano, President of the National Association of Sports Officials, wonders if referees will be comfortable with the new rule.
"We don't want to be judging medical conditions like concussions because we're not medical people and we're not trained in that area," he says. "However, if a rule or management policy says that we're to use our own judgment to decide, we're going to try our best. If the NFHS or NCAA needs us to do some enforcing, we certainly will."
Koester hopes the new rule will be seen as something that empowers officials to protect athletes. "We're asking an awful lot of coaches and administrators in this area," he says. "It only seems fair to also ask referees to do their part. It should be as collaborative an effort as possible."
To help everyone in their roles, both the NFHS and NCAA are currently working on beefing up their educational materials. In June, the NFHS plans to release a 30-minute educational video for coaches, officials, athletic directors, and parents. And the NCAA is revisiting the concussion education section of its Web site.