Concussion safety: New policy harnesses clinical evidence to drive advocacy

On a crisp fall afternoon, the schoolyard pulses with the sound of shouts, whistles and pounding cleats. But as the seventh-grade football team’s offensive and defensive lines charge toward each other, two players collide and fall to the ground. The team’s athletic trainer rushes onto the field to evaluate whether either of the young players has suffered a concussion.

The laws governing how to handle this scenario vary from one state to the next, though all 50 states have passed legislation on evaluating and managing young athletes’ concussions. To help guide osteopathic advocacy in this area, the AOA House of Delegates recently approved a comprehensive, evidence-based policy detailing how coaches, athletic trainers, school nurses, physicians and parents should work together to care for potentially concussed young athletes. Here’s a look at the AOA policy’s key points:

• Young athletes who might have experienced a concussion should stop practicing or playing immediately.
• Sideline assessments for concussion can be performed by licensed health care professionals, such as school nurses or certified athletic trainers, who have current concussion training.
• If sideline health care team members suspect a concussion, a physician with concussion management expertise must examine and diagnose the athlete.
• For athletes who’ve had a concussion, the physician will develop a treatment plan that includes when the athlete can return to his or her sport. The physician will also work with school officials to create a “return to learn” protocol that allows for cognitive rest until the student’s symptoms decrease.
• Parents, students and guardians should learn about the health risks and warning signs of concussion through evidence-based information disseminated by schools and youth sports organizations, and should sign documents stating they’ve received such resources.

Related

• At the start of the athletic season, all athletes should receive baseline testing that evaluates their balance and cognitive function. For youths who later sustain a concussion, these baseline assessments can be compared against post-concussion testing to determine whether their function has been affected.

Future advocacy

Joel M. Kase, DO, MPH, who helped develop the new policy, says it reflects physicians’ role as leaders of a multidisciplinary team that can also include physical therapists, certified athletic trainers, occupational therapists and neuropsychologists. “Because of physicians’ comprehensive education and training, they are uniquely qualified among health care professionals to recognize the subtle, variable symptoms of concussion,” says Dr. Kase, an emergency medicine physician in Augusta, Maine.

The AOA plans to take the new policy on the road by tracking concussion-related legislation across the country and advocating for greater consistency between states, says AOA Legislative Associate Raine Richards, JD. “By providing unified, evidence-based information on concussion management, the AOA can help states as they update concussion legislation to address this public health risk,” she says. In addition, the AOA will continue to monitor clinical evidence on concussion protocols so the policy can be re-evaluated as needed.