Photo Credit: Heston Quan

Athletes in many sports that involve contact, either against opponents, teammates or with the ground/floor, are susceptible to concussions, a brain injury that interferes with normal brain function. Concussions are one of the most common sports-related injuries. It is estimated approximately 1.0-1.8 million sport-related concussions occur per year in the U.S., according to Kelsey Hansen, MA, ATC; Josefine Combs, PsyD; and Verle Valentine, MD.

Sports officials at all levels are encouraged more than ever to be aware of common signs and symptoms of an athlete who may have suffered a concussion. Any player who exhibits signs, symptoms or behaviors consistent with a concussion (such as loss of consciousness, headache, dizziness, confusion or balance problems) must be immediately removed from the game.

Officials are not expected to make a medical diagnosis. They are to look for signs.
Illegal activity is an overlooked risk factor for sports-related injury. Reducing illegal activity through education and enhanced enforcement of rules about the dangers of illegal activity is necessary to reduce sports-related injuries.

The NFHS has language in its rulebooks that reads, “No athlete should return to play (RTP) or practice on the same day of a concussion. Any athlete suspected of having a concussion should be evaluated by an appropriate health-care professional as soon as possible. Any athlete with a concussion should be medically cleared by an appropriate health-care professional prior to resuming participation in any practice or competition. After medical clearance, RTP should follow a step-wise protocol with provisions for delayed RTP based upon return of any signs or symptoms at rest, while doing school work or with physical activity.”

Similar language appears in NCAA rulebooks.

For officials working under NFHS and NCAA rules codes, sports law expert Alan Goldberger suggests using the following checklist regarding rules and guidelines governing removal of a player and return-to-play:

Injury Mechanics

• Beckon coach/medical personnel.
• Observe player and look for any behaviors on list. If no symptoms are apparent, ask questions of player per guidelines.
• When directing removal of the student-athlete from the game, use the language of the rule.
• Do not discuss cause of injury.
• Do not converse with spectators/parents/opponents.
• Partner should observe process while continuing to supervise court/field and players.
• Record removal of player. Note time of substitution and if at request of coach or official.
• Note if athlete is injured or ill, but not removed under “concussion rule.”

Words to never use:

“He may have had a concussion.”

“It looks like a concussion to me.”

“I am removing her because I suspect a concussion.”

“I don’t think she should return to the game today.”

Since the 2013-14 sports season, the Ohio High School Athletic Association has required officials to show evidence of completion of either the NFHS or Centers for Disease Control concussion course when registering for a license. The NFHS course, “Concussion in Sports: What You Need to Know,” is available at The course can help coaches, students, parents, school administrators and officials understand issues regarding concussions.

The NFL mandates an observer in the press box to communicate directly with the sidelines to make athletic trainers or physicians aware of possible undetected injuries during games. An officiating observer is stationed in the press box for each NFL game. Although the observer is not specifically looking for head injuries or concussions, those types of injuries have been a point of emphasis.

Washington state is considered a pioneer in rules concerning young athletes and concussions. In 2009, it passed what is known as the Zackery Lystedt Law, which prohibits young athletes who show signs of a concussion from returning to play without a licensed health-care provider’s written approval.

Lystedt was a junior high school football player who suffered an apparent concussion in a game. He subsequently returned to action in the same contest and later collapsed and was rushed to the hospital where doctors had to operate on his hemorrhaging brain. Lystedt is in a wheelchair today, but he can talk and see again.

Officials can’t prevent concussions from occurring. But they must react accordingly when one is suspected.

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