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NFHS Tightens Concussion Rules

Football players, coach and refereeThe National Federation of State High School Associations (NFHS) has passed a new concussion rule that goes into effect for the 2010-11 academic year. Under the new rule, "any athlete who exhibits signs, symptoms, or behaviors consistent with a concussion … shall be immediately removed from the contest and shall not return to play until cleared by an appropriate health-care professional."

This rule is a major change. The previous rule only required officials to remove any athlete from play who was "unconscious or apparently unconscious." The new rule reflects the fact that up to 90% of athletes who suffer concussions do so without ever losing consciousness.

Covers youth leagues too

This new rule not only impacts high schools; it also covers the numerous youth leagues that play under high school rules or modified high school rules.

High school parents and youth league parents should note the following important facts about this new concussion rule:

  • Power to remove from play. Both game officials and coaches will now have the power to remove an athlete from a game if exhibiting signs or symptoms of a concussion. If an official removes an athlete, he should communicate the reason for an athlete’s removal to the coach, and to the rest of the officiating team to avoid any possible confusion as to why a potentially concussed athlete has been removed or his premature return to the playing field.
  • Power to clear athlete to return to play. Once an athlete is removed from a game, only "appropriate medical personnel" can deem a player suitable to return to play.
    • What consititutes appropriate medical personnel will vary. Each high school state association and every youth program that follows NFHS rules will need to specify which medical personnel qualify as "appropriate medical personnel." In some states a certified athletic trainer (ATC) will qualify, in others he won't. In some states a nurse practitioner will qualify; in some they won't.
    • Guessing will get a program in trouble. Youth leagues will then need to educate their members as to that definition or specify a modification from the high school standard in their state. A failure to educate will result in inconsistent enforcement, providing a disservice to the athlete, and increasing liability risks should harm occur to an athlete.
    • Officials should note when they removed an athlete and when the athlete returned. Officials should not have to ask for a written note from the medical personnel that authorized the athlete’s return to play. Once the athlete is removed, the official’s duty is over. It should be up to the school or team to obtain an assessment from "appropriate medical personnel.
  • Return to play procedure. Each high school state association will also need to develop a return to play procedure. Youth leagues that follow NFHS rules will need to know that procedure, and educate their members. If a youth deviates from the high school standard, it needs to specify its modification.

Education and Training

  • Officials. Under the new rules, high school and youth league officials have both a legal and a professional obligation to be trained on the signs and symptoms of concussions.
    • Officials who haven't received adequate training will be in the uncomfortable legal position of acknowledging that they are completely ignorant about an important safety standard. That won’t look good in court.
    • Officials who aren’t trained also are failing their professional obligation to study the rules of their sport. If the rules say that an official must be able to recognize the signs and symptoms of a concussion, then an official needs to learn them, just as the official learns his or mechanics, and learns the playing rules of her sport.
  • Coaches. High school and youth league coaches also have a legal and professional obligation to be trained on the signs and symptoms of concussions. High school coaches will undoubtedly be required to take training by their state governing body. Youth leagues don’t always come under the umbrella of national or state governing bodies that can mandate coaching requirements. The wise youth league will implement a training program.
  • Training video. One of the most convenient educational tools for coaches and officials is the NFHS’s free on-line video training tool. Simply go to www.nfhs.org to find the concussion training video. I strongly suggest that any league that doesn’t have its own training program make this required viewing. This video will be vital for youth leagues, youth coaches, and youth officials. Of course, groups that want a more detailed training should work with local medical professionals who are willing to help.

State law governs

At least seven states have passed concussion safety laws in the last 18 months which take precedence over the NFHS rule. At least one state, New Mexico, bars a player from returning to play sooner than seven days after suffering a suspected concussion.

A number of state high school athletic associations have also enacted concussion safety rules.

In California, the California Interscholastic Federation (CIF), the state's governing body for high school sports, has passed a bylaw more stringent than the NFHS rule. It bans same day return to play if a coach or official removes the player for exhibiting signs or symptoms of a concussion – even if a doctor subsequently determines that the player does not have a concussion. This rule means that a coach or official without medical training overrides the doctor who concludes that there is no concussion. Coaches, school administrators, and league administrators must know whether their state has legislation that addresses concussed or potentially concussed athletes, and takes precedence over the NFHS rule.

The bottom line is that rules on concussions are in a state of flux and that the new rules have created some confusion. The good thing, though, is that athletes are being better protected against concussion, and our sports world is a safer place.

Created August 16, 2010