School leaders, parents and coaches are challenged to ensure the safety of athletes participating in interscholastic programs, including concussion management. With an estimated 300,000 sport-related concussions occurring annually in the United States and a public perception that bell ringers are not concussions, many head-injured children are being allowed to continue to play through their symptoms. That decision puts those athletes at additional catastrophic risk. While several states have passed legislation to set minimum concussion management guidelines, an alarming need still exists to better educate those on America's sport sidelines. This article provides school leaders, parents and coaches with a snapshot of appropriate concussion management practices by presenting policy recommendations for establishing uniform guidelines consistent with the current published literature. It also provides recommendations to teachers for making classroom accommodations for athletes with concussions.
Every year, an estimated 300,000 sport-related concussions occur in the United States with high school football players suffering nearly one quarter of those injuries (Cantu, 1 998; Centers for Disease Control and Prevention, 1997; Guskiewicz, Weaver, Padua & Garrett, 2000; Sosin, Sniezek, &Thurman, 1 991 ). The statistics are staggering: by the time their high school playing career is complete, more than 60 percent of all teenage athletes will experience some type of concussive injury (Collins & Hawn, 2002). Even so, many concussions sustained by younger athletes go unreported because youth sport coaches, parents and even athletes themselves do not fully understand what concussion is or that it has occurred (Collins et al., 2003; McCrea, Hammeke, Olsen, Leo & Guskiewicz, 2004).
The prevalence of the injury along with the increasing number of cases involving a catastrophic outcome has forced school leaders nationwide to consider the development of specific policies to better protect their athletes. Recommended are policies that specifically direct coaches and parents how to identify concussive injuries, how those injuries should be managed, and the process by which athletes should be allowed to return to physical activity following a concussive injury. It may also be necessary for school leaders to recommend classroom accommodations.
THE PUSH FOR UNIFORM MANAGEMENT GUIDELINES
In October of 2009, the United States Congress opened up hearings to investigate the management of concussion with professional athletes in the National Football League (NFL). The national spotlight was focused on the life altering, long-term consequences of the injury to NFL players, however, it is clear that concussive injury has more far-reaching implications. Nowhere is this more evident than in our nation's school sport programs. Many state high school athletic associations require coaches to undergo first aid and CPR training, nevertheless, this training typically falls short of addressing the catastrophic risks associated with concussion. A handful of states have stepped forward to make sure schools take notice. In the last five years, Connecticut, Idaho, Oregon, Texas and Washington passed legislation to establish minimum concussion education and/or management guidelines.
The topic of national concussion legislation is also being considered in an effort to ensure schools are doing their part. Representative William Rascrell (D-NJ8) has sought to amend Title III of the Public Health Service Act for three straight years. Raserei l 's bill, the Concussion Treatment and Care Tools Act, would provide for the establishment and implementation of national concussion management guidelines with respect to children aged 5 to 18. It would also establish guidelines for when injured athletes could return to physical activity (Concussion Treatment and Care Tools Act, 2008; Concussion Treatment and Care Tools Act, 2009). …