Whether the city that threw snowballs at Santa wanted to be or not, Philadelphia is now the epicenter of football concussions. Judge Anita Brody of the Eastern District of Pennsylvania could very well determine the fate of the NFL this year based on her rulings in the massive, multi-district concussion litigation that has more than 4,000 plaintiffs. It is fitting that one of the City of Brotherly Love’s smartest legal minds decided to tackle the issue of concussion legislation to make some sense of the myriad of U.S. laws supposedly aimed to preventing “traumatic brain injuries” or TBIs, among young athletes.
In a recently published study in the American Journal of Public Health, Temple Law Prof. Hosea H. Harvey, J.D., Ph.D., sought to describe current state-wide youth sports traumatic brain injury (TBI) laws and their relationship to prevailing scientific understandings of youth TBIs, and to facilitate further research by creating an open-source data set of current laws. What Harvey found, however, is a bit troubling.
Harvey’s article, “Reducing Traumatic Brain Injuries in Youth Sports: Youth Sports Traumatic Brain Injury State Laws,” discovered that American TBI laws do not actually work to prevent the initial injury. Harvey found that since concussions exploded onto the national radar in 2009, forty-four states and Washington, DC have passed youth sports TBI laws. Yet, no state’s youth sports TBI law focuses on primary prevention. Instead, such laws focus on (1) increasing coaches’ and parents’ ability to identify and respond to TBIs and (2) reducing the immediate risk of multiple TBIs.
Harvey’s article raises concerns about the relationship between the state-level youth sports TBI laws and current public health knowledge and practice. For example, most state laws establish a minimum 24-hour period of youth athlete removal, but there is no scientific agreement about the optimal minimal time someone who has suffered a sports-related TBI should be removed from play. Further, the laws do not incorporate scientific consensus that youth concussions vary based on factors such as age, gender, or the type of sport being played. Part of the problem is also that no state comprehensively tracks TBI data (by state, by age, by sport),and, therefore, estimates about the scope of the problem vary widely.
According to the study, the laws generally adhere to the framework in the Lystedt law, which follows a secondary prevention model aimed at avoiding re-injury. The law is named for Zackery Lystedt who, in 2006, suffered a permanent brain injury following his return to a middle school football game after sustaining a concussion.
Individuals who suffer TBIs and resume play too soon may be at greater risk of second-impact syndrome, which may have serious health consequences. The Lystedt law, which is essentially the law followed in every other state, outlines three core elements to prevent secondary concussions: (1) annual education for athletes and parents; (2) mandatory removal from play for athletes suspected of having concussions; and (3) clearance by a designated health professional before a concussed athlete can return to play.
“Yet, despite the similarity in such laws, states have taken a myriad of approaches on two key issues: who is qualified to assess an athlete’s return to play and whether blanket liability waivers should be provided to those who aid in the assessment or prevention of youth sports TBIs,” Harvey said.
Beyond that, the study finds that the laws do little to directly regulate any individual sports, such as by banning certain maneuvers or prohibiting certain types of contact.
“The laws are fairly uniform, so they are not specifically tailored to particular issues arising in various states, various sports, or in certain youth sub-populations,” said Harvey. “The legislative response has been rapid, but it remains a work in progress. These laws admirably focus on secondary-level prevention, but more should be done to address primary prevention in vulnerable youth athlete populations.”
To that end, the article suggests that these state-based laws are only part of a comprehensive youth sports TBI-prevention framework. Additional actions, such as changing sports rules, utilizing equipment technology, and identifying better education programs, could be taken to bolster efforts at preventing TBIs in youth athletes.
Prof. Harvey’s research was commissioned by the Public Health Law Research program of the Robert Wood Johnson Foundation. His interactive map and data set for state TBI laws can be found here.