Massachusetts Sport Concussion Law – Unanswered Questions

In our continuing review of the proposed Massachusetts scholastic concussion law, it is important to comment on a couple of more issues.  First, the law seems to leave an awful lot up to the “Department” to standardized concussion standards.   Second not even the  “Department” is given the discretionary power to rule just how many concussions are too many for a scholastic athlete.  The full language of the proposed law can be found at http://www.tbilaw.com/blog/2010/06/massachusetts-senate-approves-sports-concussion-bill.html

The proposed law begins with the following directive:

“The department shall direct the Division of Violence and Injury Prevention to develop an interscholastic athletic Head Injury Safety Training program.”  Then the Department is told: “the department may use any of the materials readily available from the Centers for Disease Control and Prevention and the American Red Cross.”

The CDC is a good start.  Some of the information they provide on concussion is first rate, including the Facts for Physicians http://www.cdc.gov/concussion/headsup/pdf/Facts_for_Physicians_booklet-a.pdf But I have been saying for a very long time that concussion diagnosis must include some significant investigation of amnesia, done hours and days after the injury.  The CDC has only a very superficial evaluation of amnesia.  What needs to be done is create a protocol to ask the injured person a series of questions about what happened in the period of time between five minutes after the concussion and two or three days after the concussion.

This should be easy with an athlete.  Ask them questions about what happened in the game after they got hurt.  How did the game end?  What did you observe while you were on the sidelines?  If the athlete went to the hospital, what was the weirdest thing you saw while you were in the ER?  The next day, what do you remember about what you did yesterday?

The second concern is the inquiry re: prior head injuries with no guidance as to how to apply what is learned from the inquiry.  The law doesn’t say when to hold a player out because there have been too many concussions.  I realize that this type of issue can’t be reduced to a bright line rule, but I believe the Department should promulgate some guidance on the issue. Further, there needs to be  clear cut rules when there are multiple concussions in the same year.  For example, no athlete should ever have the chance to suffer a third concussion in one season.  If I were a parent, there would be no chance for a third concussion ever.  At a minimum, a trained neurologist or neuropsychologist should clear anyone with a prior concussion to play at the beginning of the season.

I applaud the Massachusetts Senate for taking this initiative.  Lets hope they refine these rules so that they truly protect the scholastic athlete.  When to return an athlete to play is a cost benefit analysis.  You can’t sideline a professional quarterback indefinitely because of one concussion. But with an amateur athlete, there is no economic cost associated with being careful.

All those being trained under this new law should have that as their motto.