Returning a Student Athlete to Play after a Concussion: A Deadly Risk

Returning a Student Athlete to Play after a Concussion: A Deadly Risk

Student athletes, particularly those who play contact sports, are always at risk of being injured. About 9 percent of all high school sports injuries involve concussions. In 2009, almost 250,000 children were treated in emergency departments for concussions that occurred during sporting or recreational activities. Since many concussions go unreported, that statistic vastly understates the number of brain injuries that student athletes endure. The American Academy of Neurology estimates that between 1.6 million and 3.8 million minors sustain sports-related concussions every year. Coaches usually remove players from the game after a severe ankle sprain or dislocated shoulder, simply because the player will not be effective until the injury heals. They are less likely to remove student athletes who experience a concussion. Some coaches fail to recognize the symptoms of a concussion while others think “getting your bell rung” is just part of the game. Too often, coaches return concussed athletes to the playing field. That decision dThe teamatically increases the risk that a second concussion will cause a life-threatening traumatic brain injury or permanent brain damage.

Understanding Concussions

Concussions are traumatic brain injuries that disrupt normal brain functions. Most concussions are caused by a blow to the head. They occur during sporting events when players collide, when a player runs into a wall or pole, or when a player’s head strikes the ground after a fall. A violent movement that causes the brain to shake within the skull can also produce a concussion, even in the absence of a direct blow to the head. Not all blows to the head produce concussions. Unless the athlete lost consciousness, whether the player sustained a brain injury is not always clear. In the past, a coach would check for a concussion by asking an athlete to count the number of fingers he is holding up or to name the president. Current recommendations call for a trained member of the coach’s staff to examine an athlete who sustained a blow to the head for any of the following symptoms:

• headache
• dizziness
• disorientation
• blurred vision
• nausea
• memory loss
• difficulty concentrating
• feeling dazed
• loss of balance

Since symptoms may last only a few minutes, it is important to evaluate the athlete immediately. In most cases, persistent symptoms will resolve within hours or days. Healing occurs more quickly during periods of rest. Athletes who suffer a concussion usually make a full recovery if they follow their doctor’s recommendations. In some cases, a concussion causes bleeding or swelling of the brain. Those conditions can be fatal if they are not treated immediately. The most serious risk of a lasting brain injury, however, comes from a second concussion that occurs before the first concussion has fully healed.

The risk of returning to play

Concussions that produce minor injury to a healthy brain typically heal without lasting damage. During the healing period, however, the brain is particularly vulnerable. The consequences of experiencing a second concussion before the first one has healed can be devastating. “Second impact” concussions can produce brain damage that does not reach a state of maximum healing for months. Often the damage is permanent, causing lifelong cognitive impairment. Traumatic brain injuries that follow a second concussion may result in learning disabilities, short attention spans, poor concentration, and difficulty placing thoughts into words. Brain injuries can also affect balance and coordination and can lead to personality changes. In the past, coaches encouraged players to “play through the pain.” Athletes wanted to do just that, either to prove their toughness or to demonstrate their loyalty to the team. For those reasons, student athletes often returned to play within minutes of sustaining a concussion. Despite efforts to educate coaches and players about the risks of returning to play after a concussion, too many coaches leave that decision to the athlete. Some even encourage the student to “shake it off” and get back into the game. At the college level, where coaches need to win in order to keep their jobs or advance their careers, the pressure to return the best athletes to the field of play can be difficult to resist. In response to a recent survey, more than half of the athletic trainers and sports medicine professionals who work for major NCAA football progThe teams reported feeling pressured to return athletes to play after they were diagnosed with a concussion. Almost half of the schools that responded to a 2010 NCAA survey admitted returning athletes to the same game in which they experienced a concussion.

New Standards for Managing Concussions

The American Academy of Neurology and the American Medical Society for Sports Medicine have established similar guidelines for the management of concussions that occur during a sporting event. In a nutshell, coaches and trainers should:

• Remove every player from the game who suffers a blow to the head, who complains of a headache, or who begins to exhibit signs of confusion or disorientation
• Examine that player for symptoms of a concussion
• If a concussion is even remotely suspected, have the player evaluated by someone on the sideline who has been trained to use assessment instruments to determine whether a concussion occurred
• Hold the player out of the game unless the sideline evaluation rules out any possibility of a concussion
• If the evaluation does not rule out the possibility of a concussion, have the player evaluated by a physician who is trained to diagnose concussions
• Encourage the player’s friends and family to monitor the player for symptoms that could suggest swelling or bleeding of the brain
• Follow the healthcare professional’s recommendations for a gradual return to normal physical activity
• Prevent the player from resuming practice or play until a qualified medical professional (preferably a neurologist) clears the player to resume participation

California law requires school districts and private schools with athletic progThe teams to implement some of the “return to play” guidelines. Unfortunately, coaches do not always follow the rules. Whether through carelessness or indifference, student athletes are still returned to play after experiencing a concussion.

Traumatic Brain Injury Lawsuits

Traumatic brain injuries are the leading cause of death during childhood. When permanent brain damage or death occurs as the result of a coach’s decision to return a player to a game, the coach and the school or recreational league that employs the coach can be held responsible. Children and young adults who experience lasting traumatic brain injuries have special needs. They may require private tutoring to help them learn or vocational training to help them find a job they can handle. Caregivers or private nurses may be necessary to assist parents with the burden of caring for brain injury victims. Years of advanced neuropsychological testing and treatment may be necessary to monitor and respond to changes in the injury victim’s condition. Victims who experience serious traumatic brain injuries because of a coach’s negligent “return to play” decision are also entitled to compensation for their loss of future income, pain and suffering, emotional distress, and loss of enjoyment of life. No amount of compensation can give a child the life that he or she would have had before the injury occurred, but compensation can allow the child to live an easier, more enjoyable, and more productive life. An experienced personal injury lawyer can evaluate the possibility of winning compensation for a traumatic brain injury caused by a coaching staff’s failure to understand or apply accepted standards for managing concussions. Since claims for compensation are subject to time limits, parents and friends of injury victims should seek legal advice as soon as they become aware that a poor “return to play” decision may have caused a student athlete to suffer from a serious traumatic brain injury.