This fall, Pennsylvania state law requires all high school coaches pass tests related to concussion management.
The reasons for the new law are plentiful, according to the Pennsylvania Medical Society.
Take Ethan Blum, a rising lacrosse star at Carlisle High School, for example. During his 9th Grade season last spring, Blum played in nearly every junior varsity game and was one of its top scorers. He even earned some varsity time on Carlisle’s PIAA District III Championship squad.
For Blum, who excels in the classroom, it was difficult taking time off just as his high school career was starting. But, following protocol directed by state law, he did. And it didn’t take long for him to return to action when his brain was ready.
For Blum, his journey to recovery started when a coach recognized the signs that he may have experienced a concussion. Immediately he was sent to an athletic trainer, and not long after that a physician.
“I had to completely shut down my brain to recover,” Blum said. “That meant no lacrosse, no school, no tv, and no video games.”
William C. Welch, MD, president of the Pennsylvania Neurosurgical Society, says Blum’s story is classic when it comes to how concussions happen in sports, and he’s glad the state law that was followed helped in the recovery process.
“There’s a greater awareness of concussions today than there were years ago,” says Dr. Welch, a practicing neurosurgeon at the University of Pennsylvania. “State law has raised the awareness level, and when someone has their ‘bell rung’ there seems to be more caution.”
Dr. Welch says that a concussion is a traumatic brain injury that can be caused by a blow to the head or body or possibly even a fall. Essentially what happens is that the impact jars the brain inside the skull.
“Most people associate a big hit with a concussion, but it doesn’t have to be,” says Bruce MacLeod, MD, president of the Pennsylvania Medical Society (PAMED), which lobbied in favor of the new law. “Soccer players ‘heading’ the ball have been known to develop concussions. All it really takes is the brain shaking around inside a person’s head.”
Symptoms can vary, and may not be the same from patient to patient. But in general, there are some common signs that coaches are trained to investigate during a practice or game. These include problems thinking or remembering, headaches or dizziness, nausea or vomiting, and an athlete feeling tired. Outside a practice or game, the student-athlete may see changes in their sleep patterns or have a change in their emotions. Parent-coach communications is important in the latter symptoms.
The state law has several parts. The most important section of the law is likely the mandatory online training course that each coach must complete every year. The course, titled “Concussion in Sports – What You Need To Know” and provided by the National Federation of State High School Associations, walks a coach through the science behind concussions and trains them to recognize the symptoms. Coaches are taught “when in doubt, sit them out.”
But the state law goes beyond just education. The law also provides guidance on the steps that must be taken for a student-athlete to return to competition. In a nutshell, the coach is not permitted to return a player to participation until the athlete is evaluated and cleared for return in writing by an appropriate medical professional. Specifically, the medical professional must be a licensed physician, certified health care professional, or psychologist trained in the evaluation and management of concussions.
Coaches who do not comply face harsh penalties. A first violation requires suspension for the rest of the season. Second violation adds a suspension for the next season, while a third violation is a permanent suspension from coaching.
In Blum’s case, before returning to his sport, he was required to pass progressive sport-specific challenges such as running to see how his brain would react. He passed the challenges, and after about 10 days out of play was cleared to participate again.