Winning the Battle
Massachusetts’ Sports Concussion Law and a new era of TBI
Lewis Howe
Executive Director
The Safety Institute
August 22, 2012
Why concussion laws are needed
Sea change of thought: We now know Concussions are Traumatic Brain Injuries, not “dings” or
“getting your bell rung”
Chris Nowinski and Dr. Robert Cantu discovered and promoted link between repeat brain injuries
and CTE. Founded Sports Legacy Institute in 2007.
Nowinski’s book, “Head Games,” alerted the media to this public health problem.
Initial state laws on managing sports concussions were enacted in Oregon and Texas.
We drafted original MA legislation in 2009. Filed by then-Sen. Steve Baddour. We were sixth state
to enact such a law in July 2010.
As of July 2012, 39 states plus D.C. have enacted sports concussion laws.
MA was first to require doctors to receive training in managing head injuries in order to sign off
kids to return to play. (takes effect 2013)
Dream Team of Experts
• MA “Return to Play Advisory Committee”
Alan Ashare, Mass. Medical Society
Alex Taylor, Boston Children’s Hospital
Anne Sheetz, School Nurse coordinator, MDPH
Greg Parkinson, AAP, MA Chapter
Janet Kent, South Shore Hospital
Joe Scott, Southcoast
Lauren Smith, DPH Medical Director
Neal McGrath,
Nikolaus Kashey, Bay State Health
Paul Rosman, BMC
Robert Cantu, Emerson Hospital/SLI
Robert Harney, Hallmark Health
Sharon Hoover, Emerson Hospital
Bill Meehan, Childrens Hospital
Governing Regulations
• RTP Panel wrote strongest, most detailed regulations to date.
• “Any student who during a practice or competition sustains a head
injury or suspected concussion” shall be removed from the
practice or competition and may not return to the practice or
competition that day.
• Triggers several steps for medical clearance known as “graduated
Requirements for Parents and Students
• Must take CDC’s on-line education course on sports concussions
at beginning of each school year.
• Sign and submit pre-participation form that provides school with
student’s medical history.
• If child is injured during the season, parent must complete Report of
Head Injury Form and submit to appropriate school personnel.
Requirements for Athletic Directors
Complete the annual on-line training
Participate in the development and review of school concussion policies. All schools must submit
comprehensive policies to state Dept. of Public Health
Ensure that all staff, parents, volunteers coaches and students complete training as mandated by
Manage all pre-participation and head injury incident forms, unless school policy designates
other person(s) to do so.
Report annual concussion statistics to MDPH.
Ensure that athletes are prohibited from engaging in any unreasonably dangerous athletic
technique that endangers the health or safety of an athlete, including using a helmet or other
sports equipment as a weapon (taken from TX law).
Requirements for Coaches
Completing on-line annual training
Reviewing pre-participation forms so as to identify those athletes who are at greater risk for head injuries.
Completing a Report of Head Injury form upon identifying a student with a suspected concussion that occurs
during practice or competition.
Reviewing Report of Head Injury forms submitted by parents who report a head injury during sports season that
occur outside of organized athletic activity.
Transmitting forms PROMPTLY to school nurse for timely and accurate updates to students’ health records.
Teaching safe play techniques, discouraging dangerous play such as helmet to helmet hits.
Identifying athletes with head injuries or suspected concussions that occur in practice or competition and removing
them from play.
Role of Certified Athletic Trainers
Complete on-line training and participate in development and review of
school head injury policies.
Review pre-participation and Report of Head Injury forms to identify
students at greater risk.
Identify athletes with head injuries or suspected concussions occurring in
practice or competition and removing them from play
Participating in, if available the graduated re-entry planning and
implementation for students who have been diagnosed with a concussion.
Role of School Nurses
• All requirements of other partners, plus:
• Monitoring recuperating students with head
injuries and collaborating with teachers to
ensure that the graduated reentry plan for return
to full academic and extracurricular athletic
activities as required by the law are being
• Providing educational materials on
TBI/concussions to teachers, staff and students.
What about equipment?
• According to the National Operating Committee
on Standards for Athletic Equipment (NOCSAE):
• “Currently there is no definitive scientific
research linking mouth guards, head bands,
supplements or other specialty products to a
reduction in concussion risk or severity.”–
What to do if a child is hurt
• If you are at an MIAA-sanctioned game or practice, and
see a participant child suffer a head injury:
• Make sure the child is removed from play immediately by
coach, official, or certified athletic trainer on site.
• If it is your child who is injured, take your child for
medical evaluation immediately, report to school or
athletic team; complete Report of Head Injury form.
• If you believe rules are not being followed, do not be
afraid to speak up!
Is it working?
• MDPH--in terms of ED treatment for TBI in school age
children, the latest data we have ends 9/30/11 so we
are a year away of any ED data assessing impact.
• Only about ten percent of school districts have
submitted data to MDPH.-Boston Globe, Aug 2012
• MIAA opposed the bill when filed, has been slow to
advocate for it.
What next?
More studies of effects of TBI/concussions on human brain being released
every year.
Our understanding of risks of CTE has grown exponentially in last five years
More districts requiring IMPACT and other tests.
Additional youth leagues enacting regulations around concussion
Lawsuits against National Football League bear watching, may lead to
further regulations. Continue educating parents and players on what we
know— “when in doubt, sit them out.”
Additional resources
• Sports Legacy Institute—
•, Washington State
• CDC’s Heads Up campaign,
• Brain Injury Association of MA
• Athletic Trainers of Massachusetts
Play Safe, Stay Safe!

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