Law, Initiatives Combat Concussions In Arizona High School Sports

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PHOENIX – Mary Shannon suffered her first concussion during North High School soccer tryouts in 2011, colliding with the goalie and hitting her head on the ground.

Under a state law signed earlier that year, she had to receive written medical clearance to return to the field. That took a month.

After a collision with an opposing player left her with a second concussion earlier this year, Shannon decided that was enough. Having learned about the dangers of concussions and with encouragement from her parents, she quit, deciding to limit her involvement to refereeing and helping the team in other ways.

“Yes it’s a big part of my life, and yes, I love it, but I can still participate in it without having to put myself in the danger of getting another concussion or some other injury,” she said.

In Arizona, about 7,000 high school athletes suffer concussions each year, according to research by A.T. Still University in Mesa. While football justifiably gets most of the attention, concussions are a threat in any high school sport.

A 2011 state law requires that high school athletes be removed from play if a concussion is even suspected and then receive written clearance to return from a medical professional like a physician or athletic trainer.

The law also called for concussion-education programs for coaches, students and parents. This led to the Arizona Interscholastic Association requiring every high school athlete in Arizona to complete Barrow Brainbook, interactive online training developed in part by Barrow Neurological Institute at St. Joseph’s Hospital and Medical Center.

But the effort didn’t end with a law. Medical professionals, advocates and others have since offered free baseline cognitive testing, known as ImPACT, that helps measure the effects of concussions and established a network of concussion experts that athletic trainers can consult via telemedicine.

Soon, a voluntary registry created by Barrow and A.T. Still will allow high schools to report concussions to researchers looking to improve the safety of athletes.

Dr. Javier Cardenas, a child neurologist at the Barrow Neurological Institute, said Arizona’s approach to concussions is “really the most comprehensive program like it in the country and likely the world.”

Sen. Rich Crandall, R-Mesa, who shepherded Arizona’s law through the Legislature, said that in the end, keeping athletes safe comes down to students, parents and coaches recognizing the symptoms and keeping athletes with concussions off the field.

“If those three are on board, we’re going to be able to make a difference in Arizona,” he said.

Arizona’s law

When the National Football League approached him about following a Washington state law on concussions, Crandall said the time seemed right for Arizona.

“We’re a big high school football state,” Crandall said. “We’re not Texas, but still, it’s a big deal.”

In the process of creating the legislation, Crandall said, he and advocates found that parents can be a barrier to acting in the best interests of an injured student athlete. As an example, he described a scenario in which a student is being considered for an athletic scholarship.

“The coach is saying, ‘No, let’s pull him out,’ and the parent’s saying, ‘No, you don’t get it. My boy needs to perform in front of these coaches, these scouts,’” Crandall said.

Signed by Gov. Jan Brewer, the law established a protocol that goes into effect when a high school athlete suffers what’s even suspected of being a concussion. The athlete is immediately removed from play by either the coach, a referee or other official, a licensed health care provider or the athlete’s parent.

If the athlete is examined by a licensed health care provider and a concussion is ruled out, he or she may return to play the same day. Otherwise, the athlete cannot return before receiving written clearance from a health care provider defined by the law as a physician, a physician assistant, a nurse practitioner or an athletic trainer.

The law also requires student athletes and their parents to sign a form acknowledging they have reviewed the risks and symptoms of concussions.

Dr. John Parsons, an associate professor and director of the athletic training program at A.T. Still University, said that the narrow definition of who can clear an athlete to return to competition sets Arizona’s law apart. Laws in Washington and other states refer generally to health care providers, he said.

Parsons said the most common criticism of high school concussion laws is that there are no punishments for not following them.

“It’s more or less honors policy, and you hope that the law compels them to be compliant,” he said.

Crandall said the law doesn’t need punishments to be effective.

“The fear for a school district would be somebody filing a suit for breaking the law,” he said. “You don’t have to have punitive penalties when that’s kind of overarching from everybody. A coach puts a kid back in with a concussion and a parent sues — that’s the last thing any school district wants.”

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