Concussions: The real ethical debate Tamerah Hunt, PhD, ATC Sports Medicine

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Concussion  Many terms used for mild traumatic brain injury.  Concussion is defined as “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces” Aubrey, 2002

So what’s a concussion? Mild TBI Moderate TBI Severe TBI 90% of sports related concussions fall into Mild TBI Mild concussion Moderate concussion Severe concussion

Epidemiology  5% of all collegiate athletes receive a concussion each season  5-20% of high school athletes receive a concussion each season –89.6% had 1 concussion –9.3% had 2 concussions –<1% had 3 or more concussions McCrea, 2004; Guskiewicz, 2000; Powell, 1999

 So do we trust athletes to tell us they have a concussion? Trust Concerns

Should we eliminate sports?  Should I let my child play football? Hockey? Rugby? –Would you???

Pending Federal Legislation : Protecting Students From Concussions Act

Protecting Students From Concussions Act of 2011 H.R.429  Requires each state educational agency to issue regulations establishing the following minimum requirements by 2013 in order to receive specific federal funding: –Education of students, parents, and school personnel; –Supports for students recovering from concussions; –Best practices designed to ensure the uniformity of safety standards, treatment, and management.

Protecting Students From Concussions Act of 2011 H.R.429  Requires each public elementary and secondary school to post on school grounds and make publicly available on the school website information on concussions, including information on risks, responses, and effects.

Protecting Students From Concussions Act of 2011 H.R.429  Requires public school personnel who suspect that a student has sustained a concussion during a school sponsored activity to: –Remove the student from the activity and prohibit the student from participating until the student submits a written release from a health care professional; and –Report to the student’s parent or guardian regarding the injury and the treatment provided.

Protecting Students From Concussions Act of 2011 H.R.429  Prohibits a student who has sustained a concussion in a school sponsored athletic activity from resuming participation in school sponsored athletic or academic activities until the school receives a written release from a healthcare professional that: –States the student is capable of resuming participation; and

Protecting Students From Concussions Act of 2011 H.R.429 o May require the student to follow a plan designed to aid the student in recovering and resuming participation in a manner that is coordinated with periods of cognitive and physical rest, and that reintroduces cognitive and physical demands on a progressive basis, based on the student’s symptoms.

State Legislation In 2009, Washington State and Oregon were the first two states to pass concussion laws relating to youth athletics.

State Legislation (Cont’d) State Legislation Provisions Include: –Medical clearance before the athlete can return to play. –More stringent laws require written medical clearance. –Guidelines regarding the education of coaches, administrators, parents and athletes. –Ultimately, each State’s legislation provides a written guideline for an athlete’s return to play.

Ohio State Law  Ohio House Bill 143

Ohio’s Concussion Law  Passed and is effective as of April 26, 2013  Department of Health is required to post information sheet and links to on-line training effective March 27, 2013 – o/default/vipp/child/~/media/E1AA7B788AE94918B2 48B0FAC4648CA7.ashxhttp:// o/default/vipp/child/~/media/E1AA7B788AE94918B2 48B0FAC4648CA7.ashx

Ohio’s Concussion Law summary  Cannot practice or compete in athletics until the student has submitted a signed form stating that student and the guardian have received concussion and head injury information sheet created by Dept of Health  Sports organization must provide guardian Depts concussion and head injury sheet  Coaches must have Pupil Activity Program (PAV) permit

Ohio Law Summary continued  Officials must have PAV permits  Requires coach or official to remove athlete from play is exhibiting signs or symptoms of concussion  Coaches and officials cannot return an athlete to play until the student has been assessed and cleared by a physician or any other licensed health care provider

 Requires the department of health to create a concussion and head injury information sheet  Files/injury%20prevention/concussion/Interscholastic%20Concussi on%20Form%20-%20ODH%20Revised%202.ashx  Requires Dept of health to provide link on website to free online training programs in recognizing the signs and symptoms of concussion and head injuries. Ohio Law Summary continued

What about the law?  So who is responsible for enforcing the law?

NCAA Regulations

NCAA mandated that all schools have a concussion management program in place by the school year which must include the following provisions: –Student-athlete who exhibits signs, symptoms or behaviors consistent with a concussion shall be removed from practice or competition and evaluated by an athletic health care provider with experience in the evaluation and management of concussion management plan

NCAA Regulations –Student-athletes diagnosed with a concussion shall not return to activity for the remainder of that day –Medical clearance shall be determined by the team physician or his/her designee according to the concussion

NCAA Regulations –Student-athletes must sign a statement in which they accept the responsibility for reporting their injuries and illnesses to the institutional medical staff, including signs and symptoms of concussions –During the review and signing process student- athletes should be presented with educational material on concussions.

New laws and regulations  Will these rules make a difference in reporting?

What do we know  What do we know?

What are the ethical concerns of healthcare providers ?  Can healthcare professionals make rules to improve the safety of athletics?

Questions Tamerah Hunt, PhD, ATC