HEAD GAMES: State, KHSAA proactive in dealing with concussions (08/12)

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By Nathaniel Bryan

When it comes to keeping young athletes safe, KHSAA commissioner Julian Tackett believes his organization, as well as the state’s elected representatives and senators, have passed some pretty strong bylaws, laws and other legislation.

“The ones that were first written, like Oregon and Washington, they’re going back now and revising theirs because ours included some things that theirs didn’t,” Tackett said last week in an exclusive interview with The News-Enterprise.

Kentucky’s concussion law, House Bill 281, is a little more than a year old after Gov. Steve Beshear signed it in front of a crowd at Louisville Central.

“Participating in sports can be one of the most fun and rewarding parts of a student’s high school years,” Beshear said at the signing. “Our kids learn lessons about teamwork on the field or court that we can’t teach in class, but we’ve got to keep them safe from the potentially lifelong consequences of injuries like concussions. This is common-sense legislation to keep kids healthy while they pursue sports and their education.”

Dr. Tad Seifert, of Louisville-based Norton Healthcare, worked extensively with the bill sponsor, state representative Joni Jenkins, as well as the duo of Mary Haas and Chell Austin of the Brain Injury Alliance of Kentucky, to draft and pass the legislation.

“Concussions can occur at any age and in any sport,” Jenkins said at the signing. “Whether students are in middle school or high school, their coaches need the proper training to know the signs of a concussion. Parents and students need that information, too, and this legislation means they will get it. I thank my colleagues in the House and Senate for their bipartisan and unanimous support for these protections for student athletes.”

The protections took effect in the 2012-13 school year. In addition to coaches’ training, the law provides educational materials on how to recognize the symptoms and seek proper medical care for concussion victims will be made available to parents, students and the public.

Student-athlete physicals were already required, but the law added students and parents have received educational materials about concussions. A concussion or possible concussion meant students cannot practice or compete until they are medically evaluated.

The law requires at least one individual who has completed the safety course to be present at all practices and competitions. Schools will also have to have emergency plans for dealing with potentially serious injuries.

Before passage, the bill read, “AN ACT relating to interscholastic athletics and declaring an emergency. Amend KRS 160.445 to require coaches to complete training on recognizing and treating concussions and head injuries; identify actions required before an athlete with a suspected concussion or head injury may return to play; amend KRS 156.070 to conform; EMERGENCY.”

Tackett pointed out Kentucky’s law is more in-depth than many states’ concussion legislation.

“Just as important as ‘return to play’ was and just as important as ‘mandatory you’re out that day if you show signs that you’ve got a concussion,’ just as important to us was having a requirement that they have an emergency preparedness plan,” Tackett said. “If we learn nothing else from the unfortunate incidents that we’ve had the last 15 to 20 years where young men and women have passed away in sports, is that we have to have a plan at a facility, we have to practice that plan and we have to know that even if we’re on a JV football field at a remote location by a school, who’s going to call the ambulance, who’s going to meet the ambulance and who’s going to stabilize the kid.”

In addition to speaking all over the state about concussions – he served as a co-host of a symposium last month in Marion County – Tackett helped design an online slideshow on the KHSAA official website, www.khsaa.org, which spells out the organization’s concussion protocol for coaches and officials.

After KHSAA athletes have been diagnosed with concussions, only a Doctor of Medicine or Doctor of Osteopathic Medicine can authorize a return on a subsequent day – otherwise known as no earlier than the next day.

However, the MD or DO approval should not be given until after the KHSAA’s six-step protocol has been followed. The steps, in order, are no activity, light aerobic exercise, sport-specific exercise, non-contact training drills, full-contact competition/practice and a return to normal game play. The KHSAA recommends each step last at least 24 hours, meaning the quickest an athlete should return to play following the diagnosis of a concussion is six days.

The most notable concussion state legislation is Washington’s Zackery Lystedt Law, which was signed in 2009 after Lystedt suffered a severe brain injury after returning from a concussion to play middle school football in 2009.

The Lystedt Law contains three plateaus similar to the KHSAA and Kentucky laws:

n Athletes, parents and coaches must be educated about the dangers of concussions each year.

n If a young athlete is suspected of having a concussion, he/she must be removed from a game or practice and not be permitted to return to play. To help people remember this, the rhyming phrase “when in doubt, sit them out” was coined.

n A licensed health care professional must clear the athlete to return to play in the subsequent days or weeks.

Tackett pointed out when Oregon passed its version of the Lystedt Law, the KHSAA had already had provisions in place.

“I know that the NFL has lobbied hard for these bills, and there’s a reason that they lobby hard, but they lobby hard and they’re using our law as the model for the south to try to get some of the Southeastern Conference states to add concussion laws,” Tackett said. “Because the SEC states were the last ones. I mean, it’s SEC football. We’re not going to change football. But some of the states in the SEC have kind of come around now to what we were already doing anyway. We were one of the SEC states that had an early law. Most of them didn’t.”

Because of a variety of connections – Hardin Orthopedics & Sports Medicine, Hardin Memorial Hospital, Physical Therapy Associates or the Kentucky Orthopedic Rehab Team – the area has the luxury of having medical personnel or certified athletic personnel at most every contest, ranging from varsity, junior varsity and freshman to even middle school.

While Tackett would like to see an amendment to the law making medical personnel mandatory at athletic contests on every level, he knows legislation like that is a long ways off.

“It’s a tough balance,” he said. “We need athletic trainers at every contest. We need trainers, who are licensed, to cover every game. We know that in some areas, they do that very well. But we also know there are also some areas around the state that don’t have that luxury.

“It comes down to a money thing and unfortunately, they have got to prioritize different things,” Tackett added. “But our kids would be so much better off if we had a trainer at every school. There’s absolutely no doubt about that.”

Athletes in the Hardin-LaRue-Meade county area are required, not by the KHSAA or state but rather their school districts, to take a computerized IMPACT test prior to taking the field. The IMPACT test gives a baseline of brain function. But the test is not required every year. Furthermore, some schools in the state don’t require a similar test.

Additionally, Tackett noted the brain is constantly developing in adolescents. For example, if an athlete takes the test as a 12-year-old and never receives another baseline, the reading could be false if the same athlete doesn’t experience a concussion until he or she is a senior at 17, 18 or even 19 years old with a more-developed brain.

However, Tackett noted at least one baseline test is better than no test at all.

Tackett said while the state is on the right track, more could always be done it when it comes to protecting its young athletes.

But it’s definitely on the right track.

“We’re going to keep focusing on giving our coaches the best resources available, so maybe five or 10 years from now, we can say, ‘You know, we really haven’t had a sports medicine issue the last few years. Everything’s gone real well,’” Tackett said. “I hope we can say that some day.”

Nathaniel Bryan can be reached at 270-505-1758 or nbryan@thenewsenterprise.com.