By Chris Koutures, MD, FAAP
California Assembly Bill 2127 authored by Assembly Member Ken Cooley (D-Rancho Cordova) will take formal effect on January 1, 2015 and will provide that, if a licensed health care provider determines that the athlete sustained a concussion or a head injury, the athlete is required to complete a graduated return-to-play protocol of no less than 7 days in duration under the supervision of a licensed health care provider. This stipulation is an extension of previous California legislative mandates passed in 2011 and 2012 that require:
- Immediate removal for the remainder of the day of any high school athlete suspected of having a concussion
- Prohibit the return of the athlete to that activity until he or she is evaluated by, and receives written clearance from a licensed health care provider
- Each year, a concussion and head injury information sheet must be signed and returned by athletes and parent/guardian
- Concussion education must now be part of required first aid training of every high school coach
In discussions with coaches, administrators, and fellow sports medicine providers, I’ll throw out a few questions that have arose regarding several nuances of the law:
- When is the earliest that the 7-day return protocol begins?
- Is it potentially at the time of formal diagnosis of a concussion by a licensed provider?
- Is it when the athlete is fully cleared of post-concussion symptoms?
- Can the period begin before a formal diagnosis is made?
- What is the formal definition of supervision?
- Can an athletic trainer assume the role of supervision under the guidance of a physician?
- Given that the bill also limits contact football practices to two 90 minute periods per week, if the timing of those two practices is perhaps a day before a player’s progression is ready for contact, can he have alternate contact to possibly play in a game if otherwise having an appropriate recovery?
- Are school and medical providers aware and sufficiently prepared for these new edicts?
- Is there agreement or clarification on the above terms and concerns?
- Have concussion management plans, if already in place, been modified or reviewed to address the new mandates?
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