Let Medical Experts Make Critical Medical Decisions

A recent editorial in USA Today highlights the danger of a bill introduced in the North Carolina state legislature. House Bill 116 includes a provision that would overturn existing North Carolina law that requires that children be cleared by a licensed medical professional before returning to play in organized athletics after having experienced a concussion. While one of the co-sponsors of that bill, state representative Greg Murphy, has promised that the provision will be removed, Nancy Armour encourages “keeping an eye on legislators until the necessary edits are actually made to House Bill 116. Because parents, no matter how well-meaning, do not have the expertise to make a decision of this magnitude.” It is essential to the safety of youth athletes in North Carolina that the bill be corrected, and that licensed medical professionals continue to be involved in determining when it is safe for kids with head injuries to return to the playing field.

As Armour points out, “you can’t make decisions that will impact the health and safety of a child if you don’t have the training and the expertise to do so.” But while Armour is right in asserting that parents should not be making these decisions alone, they should still be well-informed and involved in the decision, along with a qualified medical professional, of when a young concussion victim should be allowed to return to sports-related activities. After all, given the seriousness of a concussion and the uncertainties involved with this type of injury, it is not unreasonable for parents to exercise caution in allowing their child to return to the playing field, even if a licensed medical professional has already given clearance for the child to do so. Parents need to feel confident that it is safe for their child to once again participate in sports, and thus need plenty of guidance when a serious head injury occurs.

This is a problem that affects millions of families. A study published in Pediatrics, the official journal of the American Academy of Pediatrics, last year estimated that between 1.1 and 1.9 million minors in the United States experience concussions while participating in organized sports and recreational activities each year. There is widespread agreement that these children should be closely monitored, and have ample time for rest and recovery before being allowed to return to full activity in their chosen sport. All 50 states and the District of Columbia have enacted legislation to address the consequences of youth sports-related concussions, the vast majority of which establish requirements for evaluation and clearance by some sort of health care provider, ranging from physician to athletic trainer, before the athlete returns to play.

But while state legislatures have been responsive to the need to protect youth athletes, educational outreach efforts to the families of those athletes have come up short. Being cleared to play by a physician, other medical professional, or athletic trainer is a first step, but ultimately parents will often need more than just the assurance from one individual to feel confident that it is safe for their child to return to the playing field. Parents will always be involved in critical decisions regarding the safety of their kids. The better informed they are about concussions and the risks involved in returning to full activity when meeting with a licensed medical professional, the better off their children will be.

A survey by the Women’s Sports Safety Initiative indicates that the parents of youth athletes want more information and guidance about head injuries. The survey shows that 75% of parents with children under 18 worry about concussions when their children play sports, and 90% of them believe there should be more guidelines to ensure the safety of athletes when returning to play after a concussion. Only 29% of adult Americans believe “they know all they need to know” about concussions.

While the provision of North Carolina’s House Bill 116 that would, if retained and enacted, set back efforts to improve the safety of youth sports made national headlines, there is another component of the bill that is quite promising. The bill includes a provision that would create a statewide database of catastrophic illnesses and injuries, including concussions, incurred during participation in athletics in the state. Such data would give researchers valuable insights that could, in turn, affect future public policy and allocation of resources, and lead to greater safety in youth sports.

The Women’s Sports Safety Initiative has been advocating for just such a database on a national scale. In their report released in the fall of 2016, Project Director Mary Hayashi lists this as one of the organization’s call to action items:

It will also be important to develop a better data-collection system to identify concussion trends in female and male athletes. The Centers for Disease Control and Prevention (CDC) is leading the way in this effort by establishing the National Concussion Surveillance System. This system will accurately determine the number of concussions sustained each year among both children and adults, and will track how these injuries occur. This data will then be used to prioritize and target specific programs and activities. Data-collection efforts like the CDC’s are vital to continuing to grow our knowledge of this issue in order to enact real change, and we need to support them.

The mandate from North Carolina’s HB 116 to collect this sort of information in the state would directly assist the CDC’s efforts to compile data on concussions nationally, and ultimately lead to greater safety in sports.

North Carolina’s HB 166 is definitely a bill worth watching. As originally written, it would be a major step backwards from recent public policy achievements in assuring the safety of youth athletes. But if, as representative Greg Murphy has assured, the provision eliminating the existing requirement that a medical professional clear youth athletes before they are permitted to return to play is removed, then the bill would be a welcome step forward. The fact that all 50 states and the District of Columbia require clearance by a professional with some training in dealing with head injuries before young athletes can return to full participation in organized sports is a major public policy achievement. The next step is to collect more information to inform public policy, and to educate parents.

Sources:

Armour, Nancy. Why parents shouldn’t clear kids from concussions. USA Today. Retrieved 6 March 6, 2017, from http://www.usatoday.com/story/sports/columnist/nancy-armour/2017/02/28/north-carolina-parents-concussion-house-bill-116/98544558/

Bryan, MA, A. Rowhani-Rahbar, RD Comstock, et al. Sports- and Recreation-Related Concussions in US Youth. Pediatrics. 2016;138(1):e20154635

National Conference of State Legislatures. Traumatic brain injuries among youth athletes. Retrieved March 6, 2017, from http://www.ncsl.org/research/health/traumatic-brain-injuries-among-youth-athletes.aspx

Women’s Sports Safety Initiative. Sports Related Concussions: Changing the game for women and sports. Retrieved March 6, 2017, from https://womenssportssafety.com/wp-content/uploads/WSSI-Report-FINAL.pdf

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