On April 26, Ohio House Bill 143 (HB143) went into effect.
This important piece of concussion legislation is designed to increase awareness and knowledge of concussions, set guidelines for appropriate and safe return to athletic play after injury, and standardize who can make medical decisions about returning to play. It promotes the protection of young athletes involved in sports activities at the youth, middle school and high school levels.
The awareness and knowledge begins with defining a concussion. It is a mild traumatic brain injury caused by a blow, bump or jolt to the head or by any fall or hit that jars the brain. This “invisible” injury disrupts the brain’s normal physiology, which can affect mental stamina and function. A concussion may involve loss of consciousness, but most do not.
Less than 50 percent of high school athletes report their concussions.
While a blow to the head may not seem like a big deal initially, concussion symptoms can develop immediately or up to 48 hours after the incident. It is important to be able to recognize the symptoms. The most common symptoms include headache, nausea or vomiting, dizziness/balance problems, sensitivity to light and/or noise, fatigue, sleeping more or less than usual, irritability, difficulty concentrating or remembering, and feeling mentally foggy.
In accordance with HB143, if an athlete exhibits signs and symptoms of a concussion while practicing or participating in an athletic event, the athlete will be removed from participation by the coach, the official presiding over the game or a school or a league representative. The athlete will not be allowed to return to play on the same day he or she was removed from activity.
There’s more to dealing with a head injury than the proposed regulations. If a child is removed from activity due to a possible concussion, the parents should monitor him or her for the first 48 hours following the injury. If the child experiences any of the following symptoms, he or she needs to be seen immediately in the emergency room:
- Severe/increased headache;
- Sudden vision change or unequal pupils;
- Slurred speech;
- Projectile or repeated vomiting;
- Sudden loss of consciousness or inability to arouse; or
- Any rapidly worsening symptoms.
The treatment of a concussion includes mental and physical rest. The child should avoid physical activity, television, video games, computer use, text messaging and loud music. These activities increase brain activity and can worsen the symptoms.
Aspirin and ibuprofen should not be used initially for headaches. Instead, use acetaminophen (Tylenol). Encourage your child to eat a light diet and rest.
In order for an athlete to return to play, HB143 requires that the athlete be evaluated by a physician or another licensed medical provider authorized by the youth sports organization or school district who is working in collaboration with a physician. Written clearance must be provided stating it is safe to return to practices and competitions.
It is recommended to use a health care provider experienced in the management of concussions. Since knowledge about concussions is rapidly evolving, do not be afraid to ask the health care provider if he or she is aware of the most up-to-date concussion literature.
An athlete needs to be free of concussion symptoms before beginning the gradual progression back to activity. This progression will take a minimum of five days, and the activity level and intensity increases with each stage. This progression is critical because a return of any concussion signs or symptoms during mild physical activity signals the brain has not healed and the child is not ready to return to activity. Returning a child back to play too soon after a concussion puts him at risk for Second Impact Syndrome.
Second Impact Syndrome is a catastrophic event that can occur when a second blow to the head happens before a person has completely recovered from a concussion. This second impact may be minor, but causes brain swelling resulting in severe consequences, such as brain damage, paralysis and even death. It is very important to encourage athletes to be honest about their symptoms and not feel pressure to return to sports.
Improper treatment of a concussion may also result in prolonged symptoms such as concentration issues, depression, chronic headaches and cognitive impairment. All of these can negatively affect a child’s academic record and overall well-being.
HB143 is designed to protect the athletes, but there are other things that can be done. Emphasizing the use of proper sports equipment, teaching proper sports techniques and encouraging good sportsmanship will help. But more importantly, athletes need to be encouraged to report concussion symptoms and to let a coach or parent know when a teammate may have concussion symptoms. Early recognition and treatment of concussions will help an athlete to fully recover and successfully return to physical activities.
Tina Lepley, ATC, is a certified athletic trainer in Sports Medicine at Nationwide Children’s Hospital. Feedback welcome at firstname.lastname@example.org.