Archive for the ‘Concussion’ Category

2023 Insurance Program Released for American Youth Football

The gold standard that is the envy of the competition

The American Youth Football and American Youth Cheer endorsed insurance provider, Sadler Sports Insurance, has released the new 2023 insurance program for teams /associations /conferences on May 6, 2023. Online enrollment is now be available for June 30, 2023 renewals.

The 2023 program is, once again, the gold standard in youth football and cheer insurance with an unbeatable combination of low rates, broad custom coverages, and best-in-industry automation that allows instant online enrollment and issuance of proof of coverage documents and certificates for field owners. But that’s not all: the program also provides best-in-industry risk management resources to prevent injuries before they become claims and for compliance with various federal and state laws. In addition, 97% of our clients grade our customer service as “A”.  That’s important because at some point during the policy year, clients will have coverage questions, need to add additional teams, need assistance with risk management resources, or will need to issue a certificate with special wording.

Apply, pay, and print proof of coverage documents and certificates in as little as 10 minutes

Our advanced automation is so simple and fast that you can complete the entire insurance purchase transaction and print all your documents in as little as 10 minutes. Many competitors require the completion of forms and days of waiting just to get a quote. Then, once the quote is bound, it can take several days to get the proof of coverage documents and certificates for field owners. Or, they could charge $100 extra for next day rush delivery.

We have a new feature that allows the prior years information including the certificate holder list to be pre populated so that information does not need to be input again. This results in a huge time savings.

After the purchase, we provide our clients access to our website so that they can self-issue certificates for new field owners 24/7. It’s so easy and our clients love this benefit.

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Competitors withdraw from market or take major rate increases

Many of our competitors have taken major increases over the past several years due to sexual abuse/molestation and concussion litigation as well as other losses. However, our program remains stable with June 30, 2023 rates offered at an approximate 5% decrease. 

Child Abuse Risk Management Plan Required By Federal Law and Insurance Carrier

The federal Safe Sport Act applies to all sports organizations either directly or indirectly and requires mandatory reporting of a “suspicion” to law enforcement within 24 hours; written policies to make an incident less likely to occur; and mandatory education for both adult staff and minors on the different types or child abuse, how to prevent the sexual grooming process and how to report a suspicion.  Sadler provides a free child abuse risk management plan for your adoption that is Safe Sport Act compliant called Safe Sport Child Abuse And Other Misconduct Risk Management Plan.  

Furthermore, the $1M per occurrence Sex Abuse/Molestation coverage under the general liability policy will be voided unless organizations have implemented a system to run criminal background checks, have written policies and procedures to make an incident less likely to occur, and have a written requirement to notify law enforcement in the event of suspicion. Our free Safe Sport compliant risk management plan will satisfy written requirements. See our insurance plan description for additional information.

What is being done to combat the risk of concussion/brain injury and related litigation?

Sadler Sports Insurance provides a sample Football/Cheer Concussion Awareness Risk Management Program that is strongly recommended for all teams/associations/conferences. This free program can be found under the risk management section of our AYF Insurance page. This program consolidates accepted risk management practices for easy board adoption and implementation. We recommend coaches complete the AYF coaching education program. Certification is required of head football and cheer coaches participating in AYF national championships. We also encourage coaches, volunteers and players to complete the NFHS tackling course. It is important for all teams/associations/conferences to thicken their shields by adopting and fully implementing a comprehensive concussion/brain injury risk management program. The future of our sports depends on this action and it’s the right thing to do to protect the kids.

Check out our new risk management reports

We developed the following risk management reports to keep our clients up to date in critical areas:

Sudden Cardiac Arrest (SCA) Risk Management SCA is the leading cause of death for student athletes while exercising, administrators and coaches need to be prepared to take immediate life saving action.

New Sports Anti-Violence Risk Management Sports violence and related lawsuits against organizations is on the risks.Learn how to greatly reduce the risk with the use of zero tolerance policies, codes of conduct, and serious sanctions.

Guide To Preventing Heat Stroke Death In Youth Tackle Football This comprehensive awareness training article was produced as a result of a recent heat illness death.

New Safe Sport Act Applies To Most Amateur Sports Organizations This new federal act signed into law in February of 2018 increases the standard of care required to protect youth against child abuse, molestation, and other forms of misconduct.

Parade Float Risk Management For Sports Organizations Two of our largest claims have arisen out of parade float accidents where participants have fallen from floats and have been run over resulting in significant injuries. This article will help to reduce the risk of future parade float accidents.

Managing Charter Bus Risk For Sports Organizations This is a must read for any conference/association hiring a charter bus.

Sample AYF/AYC Risk Management Plan

Our recently updated Sample AYF/AYC Risk Management Plan pulls together all of our best risk management content just for youth football and cheer.  Be sure to adopt, implement, and distribute this critical plan or similar comprehensive plan.

Be a part of groundbreaking injury studies

If you purchase your insurance through the endorsed insurance program, all Accident claims automatically become part of the database where our custom software analyzes the information to produce meaningful injury reports. This has led to groundbreaking studies on the comparison of injuries in age only vs age/weight categories and the incidence of concussions within AYF/AYC.

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AYF/AYC Member Benefits: Check out the list of impressive AYF/AYC membership benefits.

 

Please visit our webpage at www.sadlersports.com/ayf or call us at 800-622-7370 if you have any questions.

 

Saliva Test To Detect Sports Concussions Could Be Available Soon

Biomarkers in saliva test indicate head trauma

saliva based test

New research out of the University of Birmingham in England has found biomarkers the saliva test available can detect concussions in men. These results for men are within minutes. The biomarkers showcase how the body reacts and changes to head trauma hours and days after the initial incident.

The University has created the first non-invasive saliva concussion diagnostic test. The results showcased a 94% efficacy in their reporting for the male athletes.

This test has the potential to be instrumental in the early detection of concussions or head injuries. It is converting it into an over-the-counter testing kit for elite male athletes in the UK. Hopefully, if successful, it will be available to the United States as well.

But what is missing from this test?

While this is a remarkable find, testing for biomarkers in saliva has not yet commenced for women and children. Ongoing research is being conducted on the differences between male versus female concussions, with some exciting finds.

 

The Discrepancies between Male and Female Athletes

Though the exact cause remains unclear, the findings of this study show that females are potentially at a significantly greater risk for concussions than their male counterparts.

This study involving adolescent male and female soccer athletes studied sports-related concussions and the differences between the two. In their findings, most male sport-related concussions happen with direct contact with another player. On the contrary, many female athletes suffered from sports-related concussions from nonplayer contact such as heading the ball. When a player (mostly male) had a direct contact sports-related concussion, removal of play happened the day of the injury. In contrast, the female players might have had a sports-related concussion that would have gone undetected. The reason is simply that it is easier to track direct physical contact with another player. These findings revealed that the removal of males from play is approximately 1 ½ times greater than females.

How athletic trainers handle male and female head injuries is not equal either

Interestingly, when an athletic trainer was involved in the sports-related injury evaluation from the initial onset, the odds of immediate removal from the activity were three times greater for athletes, and males had a greater removal rate than the females. This study suggests the need for significant intervention for female athletes.sports concussions

Besides immediate removal, the study showed that females had a 60% to 80% greater risk for a Sports-Related Concussion than their male counterparts. Part of this finding was due to the physiological differences between the male and female athletes.

Female athletes have lesser neck strength and overall circumference in comparison to their male counterparts. Similarly, there are differences that likely make females more prone to microstructural sports-related concussions. In addition, earlier sports specialization results in a greater chance of injury and sports-related concussions. 

 What do these saliva tests and findings mean for sports organizations and their liability?

Part of this study has shown us important facts. Just because coaches cannot see a direct sports-related concussion does not mean it does not exist or did not happen. Evaluations for female athletes need as much urgency as their male counterparts. When in doubt, immediate removal from play is necessary to reduce further risk of injury. The demand for athletic trainers for both male and female sports teams to help in the evaluation process is high. Having discrepancies and differences between the two sexes in any sports organization opens the organization up for a greater risk of litigation.

Hopefully, as the new saliva test becomes readily available to male athletes, more testing can begin on females and children. This will only better aid the organization in determining a sports-related concussion in the early stages. The next steps can then be taken to help the athlete prevent a dangerous second impact syndrome injury, whether male or female.

If you are looking for more information on sports risk management and protecting your organization, please visit our extensive risk management library of resources. It includes important forms, documents, articles, videos, and risk management program templates on how to reduce the risk of injuries as well as your insurance premiums. Pay special attention to our section on brain injury/concussion risk management.

High School Contact Sports Not Connected to Brain Problems

To play or not to play?

Potential good news for those with brain injury concerns in contact sports. New research shows that any cognitive ailment present in youths who played contact sports was no more significant in those who did not play contact sports as they progressed into adulthood. The study conducted by the University of Colorado Boulder captured the responses of 11,000 youths over a 14-year period.

According to the Orthopedic Journal of Sports Medicine, by the time the studied individuals reached their 20s and 30s, those who did play sports early on were actually less likely to see the effects of mental health problems.

The rate of youth football participation in America continues to decline amid the controversy surrounding chronic traumatic encephalopathy (CTE). This decline results in the public’s altered view toward professional football and football for all ages. UCB’s findings look specifically at youth sports participation.

The results of the UCB study 

Starting in 1994, UCB selected young athletes from grades 7 to 12 for the study. Researchers categorized the athletes based on their future athletic intentions. Some planned to play contact sports (26% of males specifically noted football) and some planned to participate in non-contact sports. Others did not plan to take part in sports at all.

Then, in 2008, those same participants were asked a series of questions relating to depression or attempted suicide. Dr. David lower rate of depressionBohr, of UCB’s Department of Integrative Physiology, stated that there was no significant difference among the groups in the study. The mental state of all participants appeared to be nearly the same. In fact, the participants who played football proved to have lower rates of depression from those in other groups in the study. Those who claimed they had no intention of playing sports in their youth had a 22% higher rate of depression, as they moved into early adulthood.

NFL vs. Youth 

It’s currently hard for many researchers, parents, and student-athletes to see the long-term benefits of playing football. A select group of individuals who have played in the NFL have suffered serious cognitive and neurological damage. Still, we can’t assume that the same level of injuries will result from participation in youth football. 

The researchers concluded that more research is necessary before conclusive results can be made.

Prior study reaches a similar conclusion

Another topical study conducted by the University of Pennsylvania gathered information from 3,000 male graduates in 1957. It compared those who played football against those who did not. Of course, drastic changes have been made to the sport since the 1950s. But even then no evidence could be found linking football to mental health problems.

Final thoughts

It is important to note that the designers of the study at the UCB did not collect certain information. It could be important to know which position the athletes played, how long they played, or whether or not they received a concussion at any point. More research needs conducted to account for these variables.

Playing football, as it relates to long-term mental stability, remains one of the most controversial public safety topics today. The ultimate goal of this and future studies is to provide enough evidence for sports participants to make a valid decision if they should or should not play.

Brain injury risk management is essential

It’s good news to see some positive studies to counteract all the sensationalized studies hyped by the media about the dangers of youth contact sports. At Sadler Sports Insurance, we constantly educate our clients on the risks of brain injury and provide brain injury/concussion risk management programs that can significantly reduce risks. Here are the links to our free programs that can be adopted and implemented:

Source: “STUDY: No link between youth contact sports and future adverse effects.”; National Alliance for Youth Sports; October 22, 2019.

 

AYF Study: 2005-17 Concussion Trends in Youth Tackle Football

Provides perspective for impact of education, getting head out of tackle, and practice restrictions

The latest American Youth Football (AYF) study on concussion trends reveals that education of administrators, coaches, parents, and players is having a positive impact on the identification of and more aggressive response to concussions. On the other hand, popular initiatives to remove the head from the tackle and practice contact restrictions may have a more limited role than portrayed by various groups due to the high percentage of concussions that would not be impacted by these measures. Nevertheless, these initiatives are important components of a broad based brain injury/concussion risk management program.

Updated statistics based on Accident insurance claims for 2005-17 seasons

AYF is the largest youth football organization in the U.S. and represents a wide cross section of players aged five to 15.  The data in this study is based on Accident insurance claims filed with the endorsed AYF insurance program through Sadler Sports & Recreation Insurance. An injury questionnaire consisting of some 20 questions is completed by the authorized team official as a part of the claims filing process and the answers are input into a database. A variety of reports can be produced to drill down to answer specific questions about concussions. The study includes 4,478 injuries reported from 2005 through 2017 of which 533 are concussions. This study is a representative sample of concussion trends occurring not only in AYF, but in youth tackle football as a whole.

Concussions as a percentage of total injuries

What this tells us about the positive impact of concussion education

2017 15.55%
2016 17.38%
2015 13.80%
2014 16.03%
2013 16.48%
2012 16.34%
2011 11.53%
2010 7.73%
2009 8.20%
2008 6.39%
2007 5.86%
2006 3.83%
2005 6.72%
Total All Years 11.90%

Notice the spike in concussions reported in 2011 and continuing through 2017. This coincides with the media reports of the NFL class action lawsuit, other concussion related lawsuits, autopsies indicating CTE in deceased pro football players, and anecdotal stories of disabled pro athletes. This also coincides with the beginning of widespread and heavily publicized educational efforts on behalf of the Center for Disease Control and various football-sanctioning and governing bodies on concussion recognition, removal-from-play, medical response, and return-to-play protocols.

It appears that the media attention and educational efforts to train administrators, coaches, parents, and players are having a positive impact in that concussions are taken more seriously and reported more frequently than in past years. Suspected concussions are resulting in increased rates of emergency room and doctor office visits, and diagnosed concussions are resulting in more follow up care as pertains to return-to-play protocols. Overall, Accident insurance carriers are experiencing increased claims payouts for concussion care.

Concussion by situation (physical cause at point of contact)

What this tells us about initiatives to remove the head from the tackle and to limit contact at practice

Contact with ground 25%
Tackled by player 22%
Collision with opponent 17%
Tackling player 15%
Blocked by player 7%
Collision with teammate 6%
Blocking player 4%
Other 4%
Total 100%

The initiative to take the head out of contact as detailed by the Seahawks Tackling video or Heads Up Football (HUF) is very important, but not the magic silver bullet to solve the concussion problem in youth tackle football.

For argument’s sake, assuming that the initiative to remove the head from the tackle is 100% effective in reducing concussions (Datalys study by Kerr on HUF refutes this – see paragraph below), this would result in a reduction of concussions by 37% (sum of tackled by player 22% plus tackling player 15%). If heads-up blocking is added to this equation, that would result in a total reduction of 48% (add blocked by player 7% plus blocking player 4%). The other 52% of concussion claims that occur due to contact with ground, collision with opponent, collision with teammate, and other would not be touched by this initiative.

The above analysis assumes that HUF is 100% effective in reducing concussion claims arising from tackling and blocking. To the contrary, the Datalys study by Kerr in Table 2 indicates that HUF-only leagues have slightly higher concussion rates that non-HUF leagues. Let’s hope that future concussion studies with more participants reach a different conclusion.

On the other hand, the initiative to limit contact at practice would likely have a larger impact in reducing concussions among more categories of physical causes of loss, including contact with ground, collision with opponent, and collision with teammate.

Concussion by activity being performed

 

Tackling 34%
Running with ball 30%
Blocking 15%
Running w/out ball 6%
Shedding blocker 5%
Passing 3%
Catching ball 3%
Other 3%
Recovering fumble 1%
Total 100%

Concussion by event type (practice or game)

What this tells us about initiatives to remove the head from the tackle and to limit contact at practice

Game 67%
Practice 32%
Other 1%
Total 100%

Since most concussions occur during games and not practices, the initiative to limit contact at practice would only impact those 32% of concussions that occur during practice. With regard to the initiative to remove the head from the tackle, it’s easier to get the head out of the tackle in controlled practice drills as opposed to live action during games, and as a result, its effectiveness should be expected to be diminished as well.

Concussion by position played

 

Running back 20%
Defensive line 17%
Linebacker 15%
Quarterback 11%
Offensive line 9%
Secondary 9%
Receiver 4%
Other 4%
Practice drills 3%
Kickoff returner 3%
Kickoff blocker 2%
Kickoff tackler 2%
Punt tackler 1%
Total 100%

 

Concussion by type of play from perspective of injured participant

 

Offense 43%
Defense 43%
Other 5%
Receiving kickoff 4%
Other practice 2%
Kicking off 2%
Punting 1%
Total 100%

The kickoff accounts for 6% of total concussion injuries: 4% when receiving kickoffs plus 2% when kicking off. That statistic does not seem to be out of proportion with the total percentage of plays in a typical game that are kickoffs. Pop Warner banned kickoffs for ages 10 and under starting with the 2016 season due to perceived risks.  Based on our statistics, banning kickoffs would not appear to significantly reduce concussion rates.

Concussion and absence from play

 

2011-2017 2005-2010
1 to 3 Weeks 44% 46%
3+ Weeks 27% 15%
1 to 7 Days 10% 18%
Unknown/Not Answered 17% 14%
None 2% 7%
Total 100% 100%

The period from 2011 to 2017 shows increased absence from play, i.e. later return-to-play times, presumably due to following suggested return-to-play protocols. The 3+ weeks category shows a significant increase with significant decreases in the “1 to 7 Days” and “None” categories. This is further evidence that increased educational initiatives are having a positive impact on concussion treatment.

Concussion and weight of injured player compared to other players

 

About-average weight 79%
Below-average weight 11%
Above-average weight 6%
Other 2%
Significantly below-average weight 1%
Significantly above-average weight 1%
Total 100%

It appears that players of below-average weight are only slightly more susceptible to concussions than players in the other weight categories. Players classified as significantly below-average weight have the same percentage of concussions as players of significantly-above average weight.

Conclusions about concussions from the study of Accident insurance claims

The higher rates of concussion reporting and more aggressive medical care and return-to-play protocols seem to validate that concussion education is having a positive impact. Initiatives to get the head out of the tackle and to limit contact at practice, while not game changers in themselves, are important components of a broad based Concussion Awareness Risk Management Plan (Football and Cheer) as they have the potential to reduce a significant percentage of concussions and sub-concussive impacts. Our statistics indicate that practice restrictions may play a larger role than removing the head from the tackle. Additional studies with more participants are required before firm conclusions can be drawn on these concussion reducing initiatives.

Leading Causes of Sports Lawsuits: Improper Supervision & Instruction

Supervision: It’s more than just keeping an eye on things.

The need for amateur sports administrators to understand their legal responsibilities with regard to supervision and instruction can’t be stressed enough. In the arena of amateur sports, lack of supervision is the most common cause of action in lawsuits. Injuries resulting in these types of lawsuits are typically avoidable if proper supervision occurs. Below are the three most important reasons to stress supervision as a way to avoid legal liability.

  1. Injured people suffer and miss time away from playing the game, school, or work.
  2. If a serious injury occurs, negative media attention can have a significant impact on the success of your sports program.
  3. The loss record of your insurance program must be protected against serious losses to prevent future rate increases.

Supervision in the context of amateur sports is defined as overseeing the activities of the sports program. This includes recognizing potential hazards, implementing risk management measures, and monitoring for compliance. For our purposes, we break supervision down into two categories: general supervision and specific supervision.

General Supervision

The responsibility of general supervision falls on your risk management officer and other administrators (such as officers and board members). It is their duty to oversee the big picture of your risk management Instruction in amateur sportsprogram. They do this by instructing, training, and monitoring staff members on how to carry out their own duties of supervision.

Meeting the standard of care

The basic steps required to be taken under general supervision include appointing a risk management officer and adopting a written risk management plan. We offer templates on our risk management page to help you accomplish this task. Also important is selecting suitable staff and monitoring staff performance of their duties. This means screening staff with applications and background checks. Staff training or certification is key. We recommend seeking out a credible organization such the National Alliance for Youth Sports for such training. An integral part of any risk management plan is being able to document everything you’re doing. This certainly holds true for your policies and procedures regarding supervision.

Specific Supervision

Administrators should consider three basic questions regarding supervision.

  • What is the player to coach/trainer ratio?
  • In which area(s) are coaches/trainers trained and certified, if any?
  • Are policies in place regarding supervision, and if so is there accountability regarding current policy?

The liability risk of any sports program can be reduced greatly if the following guidelines regarding supervision are followed:

Rowdiness: Horseplay and roughhousing of participants and those on the sidelines ends in a great number of senseless and avoidable injuries in youth sports. Injuries can range from a player falling/jumping off bleachers to a teen athlete having an accident in the parking lot while showing off. Nonetheless, it is the coach’s responsibility to properly supervise players and keep them safe. Staff should be aware of this, recognize these activities, and put a stop to them using appropriate means. The first step in doing so is having an adequate number of coaches and staff members present and alert. Getting the buy-in from parents is also key to keeping such behavior to a minimum.

Supervisor-to-Participant Ratio: The ability to adequately observe, instruct, supervise and correct only occurs when an appropriate number of staff supervisors are present at an activity. Arrange ahead of time for sufficient team supervision during practices, games and extracurricular activities.

Supervisor Location: The staff supervisor should always be in close proximity to an activity. This means he or she should be able to personally observe, instruct, supervise and correct. This applies to sports activities and non-sports extracurricular activities, i.e. team outings, backyard cookouts, etc. One example of this type of situation is the drowning of a player who attended a team picnic. Another is children causing damage while climbing on a water fountain at an awards banquet.

Participants Size, Age, and Skill: Never mix participants of various sizes, ages, and skill levels. All too often we’ve seen injuries result when a younger team scrimmages an older team outside of age range. The sports organization should be restricting age range categories and prohibiting any play against outside competition if participants fall outside of these categories. Staff members of individual teams should not match players of different skill levels or sizes in dangerous drills. And staff should, of course, never personally injure participants during practice instruction.

Instruction

Instruction goes hand-in-hand with supervision because the instructor is a supervisor. Many sports organization require formal training for their coaches through organizations such as the National Alliance For Youth Sports. The training covers general topics that are common to all coaches such as the psychological needs of youth and how to respond to injuries as well as a sport specific segment. Such training can also be required by state legislative law and by municipalities as a pre condition of being able to use the fields. Such formal programs may satisfy the legal requirement for instruction training. Again, following the guidelines below greatly reduces the risk of liability.

Sport-specific techniques

Administrators should require coaches to follow best-accepted practices for teaching sport-related techniques. Coaches should receive continuing education on the latest techniques on how to run a practice and how to teach technical skills.

Put particular emphasis on the more hazardous areas of the specific sport. For example, the position of the player’s head during a tackle is a fundamental area of instruction. Likewise, in baseball/softball, it’s critical that athletes are taught the proper method for avoiding a wild pitch or how to slide  into a base.

Review of Safety Rules and Procedures

The governing/sanctioning body or sports organization should require a pre-season a review by administrators and staff of any rule changes. Likewise, a review of rules and policies with players should take place before every season and a review of specific rules prior to every practice and game.

Observations

The vast majority of lawsuits filed against clients of Sadler sports and recreation insurance allege lack of supervision and instruction. The alleged negligence is both at the administrator level due to lack of planning/oversight and the staff level as well. In particular, we have seen a number of serious injuries and resulting lawsuits arise from mixing participants of different sizes, ages, and skill levels.

No Written Medical Clearance After Concussion = $5.8 M Settlement

Don’t ignore critical return-to-play protocol

The lawsuit

In 2013, Brett Baker-Goins suffered a concussion while playing basketball for First Baptist School in Charleston, South Carolina. First Baptist is a private school under the jurisdiction of the South Carolina Independent Schools Association (SCISA). SCISA has a return to-play-protocol, which requires a signature by a physician on a written medical clearance form. Baker-Goins returned to play basketball five weeks later and suffered a second concussion. This allegedly resulted in a permanent traumatic brain injury, including delayed emotional, social, and educational development. Furthermore, Baker-Goins alleged being rushed through the return-to-play protocol and that the return-to-play decision was made too soon. First Baptist disagreed and claimed that they followed the return-to-play protocol. The court issued a $5.87 million settlement in favor of Baker-Goins.

Second impact syndrome

Second impact syndrome is a serious medical condition. It develops when a second concussion occurs Head injury settlementbefore the brain has been allowed to fully heal after a first concussion. The result can be significant brain swelling, which can occur even if the second concussion is mild.

Sadly, second impact syndrome can result in death or in serious and permanent neurocognitive injury. The current brain injury risk management practices adopted by state legislatures and sports governing bodies are primarily designed to prevent second impact syndrome through gradual return-to-play protocols. The state laws that include return-to-play protocols are known as Lysted Laws for Zachary Lysted, who suffered a fatal second impact injury in Washington state. It resulted in a $14.6 million settlement.  

What went wrong in this case for First Baptist

According to the allegations in the pleadings:

  • Baker-Goins was under the care of a physician who diagnosed a concussion. The doctor ordered him to remain home from school until his symptoms improved.
  • When Baker-Goins returned to school, he continued to suffer headaches, tire easily, and experience sensitivity to light and sound.
  • The school allowed Baker-Goins to return to basketball practice without being medically cleared in writing by a physician.
  • The coaches knew that symptoms persisted but allowed him to continue at practice.
  • Baker-Goins returned to play in two basketball games, despite continuing to exhibit symptoms at rest and exertion.
  • During the second basketball game, Baker-Goins was struck in his head in the right frontal temporal region by another player and saw stars.
  • Baker-Goins experienced worsening symptoms and was diagnosed with a second concussion.
  • It is alleged that Baker-Goins suffered serious and permanent injuries.

Alleged basis for negligence

  • Failing to get written medical clearance from a physician before allowing Baker-Goins to return to practice or play.
  • Failure to exercise reasonable care in returning Baker-Goins to practice and to play in games before he was symptom free at rest and exertion.
  • Failing to supervise a gradual return to play protocol
  • Negligence per se in violating SCISA’s return-to-play protocols.
  • Negligence in failing to adequately train coaches in concussion prevention and return-to-play protocols.

Conclusion

Schools and sports organizations must follow both their governing body and state law pertaining to return-to-play protocols after a concussion. Most require written permission by a physician. Some may allow written permission from a licensed healthcare professional.

Undoubtedly, the school could have shielded itself from the majority of its liability had it only followed its own rules and received written medical clearance. Of course, even with written medical clearance, coaches who observe continuing symptoms must remove the athlete from practice and play. They then must enter the progressive return-to-play protocols supervised by a licensed healthcare professional.

Source: Failure to Follow Protocol Results in Liability; Athletic Business; February 2019

Latest on Youth Concussions from American Academy of Pediatrics

The American Academy of Pediatrics just released an update on Sport-Related Concussions in Children and Adolescents. This 24-page report highlights the major developments in new concussion knowledge and treatment since the first report, which was published in 2010.

To follow are the points that I find to be of particular interest. Some the conclusions and actionable recommendations may be contrary to what is being disseminated by various bloggers and vendors of products related to concussions. But always remember that true science can be a very slow process and future studies may ultimately prove contrary results. If these topics are of interest, you should read the entire article for more information.

Concussions: Mechanical vs Chemical/Cellular Injury

There is no universally-accepted definition of a concussion and there are a wide range of symptoms which require individual management.

After a biomechanical injury to the brain due to either direct impact or whiplash effect, a cascade of chemical changes occur resulting in injury on a cellular level. Some of the medical terms for these are potassium efflux from neurons, increase in extracellular glutamate, upregulation of sodium-potassium ion pumps, depletion of intracellular injury reserves, and increased use of adenosine triphosphate and hyperglycolysis. All of these biochemical reactions result in decreased blood flow and increased energy demand which leads to an energy crisis.

In other words, concussions are a lot more complicated than just a bump to the head, making future research and studies necessary.

Rest After Concussions

After a concussion, an immediate reduction in physical and mental activity can be beneficial to recovery. However, prolonged restrictions of physical activities and delayed return to school can have negative effects on recovery and symptoms. A graduated return-to-play protocol should be followed under the supervision of a healthcare professional.

Reporting of Concussions Over the Past Decade

Studies indicate that the reporting of youth concussions has increased dramatically over the last decade with increases ranging from 57% to 200%. This is likely caused by the increased overall awareness of coaches, participants, and parents due to media exposure and education initiatives.

Concussions in Girls vs Boys

Female athletes are more likely to report symptoms to an authority figure than male athletes, despite Concussions in Girls soccerboth having the same knowledge.

Studies indicate that concussion rates from highest to lowest for boys are as follows: American tackle football, lacrosse, ice hockey, and wrestling. For girls: soccer, lacrosse, field hockey, and basketball.

Girls have higher concussion rates than boys in soccer and basketball.

The reasons that girls seem to be more susceptible are not entirely clear, but it has been suggested that it is due to weaker neck musculature and estrogen.

In school sports, for boys and girls combined, the following have the highest concussion rates: middle school tackle football, girls soccer, cheerleading, and girls basketball.

A study of youth tackle football for ages 8 to 12 indicates that the concussion rates are higher than in high school athletes and that 11 to 12 year olds have a nearly 2.5 increased risk as compared to 8 to 10 year olds.

Concussion incidence is higher in competition than in practice for males and females across nearly all sports.

Most Frequent Signs and Symptoms

Headache 86% to 96%
Dizziness 65% to 75%
Difficulty Concentrating 48% to 61%
Confusion 40% to 46%

Problems to Watch Out For in Post-concussion Diagnostic Tests

The most frequent sideline test used by athletic trainers is the Sport Concussion Assessment Tool (SCAT) and is available in following forms: Child SCAT 5 (ages 5 to 12) and SCAT 5 (ages 13+). These tests, which only take about 10 minutes to perform, are being constantly updated. They consist of observable signs of concussion, symptoms assessment, memory questions, neurological assessment, and balance assessment.

Symptoms can mimic pre-existing problems such as migraine, headache disorders, learning disorders, ADHD, mental health conditions, and sleep disorders. As a result, the examiner should be informed of any such condition.

Some sideline diagnostic assessment tools and checklists are not appropriate for children ages 5 to 12. Younger athletes perform worse on questions such as naming months or numbers in reverse. Concussions in youth sportsVariations are available for younger children such as the Child SCAT 5..

Tests that measure visual deficits, such as the King-Devick Test, show promise but not enough evidence from studies yet to recommend their inclusion in the SCAT.

While healthcare professionals find sideline assessment tests to be helpful, they are not to be used in isolation in diagnosing a concussion. Not enough studies exist at this time to recommend widespread use in children. Also, the value of sideline tests is minimized without a baseline test for comparison. See HitCheck for an example of an affordable sideline assessment app.

Are CAT Scans and MRIs Necessary? Which One Is Superior?

CAT scans and MRIs are critical when a severe intracranial injury or structural lesion (skull fracture or hemorrhage) is suspected, but they are not effective in diagnosing a concussion. Despite this, the use of neuroimaging increased 36% between 2006 and 2011.

Recent literature indicates that it is highly unlikely that significant intracranial hemorrhaging occurs after six hours without a deterioration in the level of consciousness. As a result, prescribing a CT without any deterioration of consciousness after six hours is unlikely to be helpful.

When neuroimaging is necessary, CT’s are more cost effective and can usually be arranged more quickly. However, children’s exposure to radiation may increase the risk of certain cancers over the long term. After the emergency period is over, MRIs are superior to CTs in detection of cerebral contusion, petechial hemorrhage, and white-matter injury.

Baseline Neurocognitive Testing

Studies conducted independently by developers of paper and online testing platforms have questioned the reliability of baseline tests from year to year. It is important for the reviewer who compares baseline to post- injury tests to understand modifiers that could alter results, such as depression, lack of sleep, failure to take ADHD medication, and athletes with musculoskeletal injuries.

The best environment for baseline and post-injury testing is a quiet, distraction-free environment, which can be very difficult to achieve for most schools and organizations.

Concerns about athlete “sandbagging” and intentionally under-performing on baseline tests are exaggerated as this can be detected.

Neurocognitive tests should not be used as the sole determining factor in return-to-play decisions.

Retirement After Multiple Concussions

The decision to retire an athlete after multiple concussions should not be tied to any specific number of concussions.

An athlete who has suffered multiple concussions should be referred to a specialist with expertise in this area for guidance.

Prevention of Concussions: What Can Be Proven By Studies

  • Mouth guards: After an initial 1954 study suggesting a connection between mouth guards and reduction of concussions, several larger studies refuted this assertion. Evidence of an advantage of custom mouth guards over non-custom remains inconclusive.
  • Helmets: Helmets were designed to reduce severe injuries such as skull fractures, subdural Football helmets and concussionshematomas, and brainstem contusion or hemorrhage. The goal of reduction of concussions has not proven to be productive. Several studies show no difference between several brands and models of helmets, both new and refurbished, in terms of severity of symptoms, frequency, and recovery time. Helmet improvements are not likely to ever be the solution to the concussion problem.
  • Aftermarket Helmet Attachments: No study has ever shown that aftermarket helmet attachments such as pads, shock absorbers, and sensors prevent or reduce the severity of concussions. The use of sensors to clinically diagnose or assess concussions cannot be supported at this time and do not have a role in decision making. See our article “Add-on Helmet Products.”
  • Other Headgear: Soccer headgear has not proven beneficial in the reduction of head-to-head or head-to-ball impact. Such headgear may actually increase the incidence of injury by encouraging more aggressive play.
  • Education: Education and awareness of concussions has proven effective in diagnosing, treating, and making return-to-play decisions. This finding is consistent with Sadler Sports Insurance injury data on concussion rates in youth baseball and football prior to 2012 and after 2012.
  • Biomarkers: Biomarkers have been investigated in playing a role in concussion evaluation. These include predisposition factors, delayed recovery, and increased catastrophic risk. These investigations are preliminary and none have advanced to use in a clinical setting.
  • Supplements: Numerous supplements have been investigated as to playing a role in preventing or in speeding up the recovery time from concussions. There are currently no studies in humans to support a benefit from supplements.
  • Neck Strengthening: Strengthening the cervical muscles and activating those muscles prior to impact has been found to reduce forces from head impact. Poor neck strength has been shown to correlate with the incidence of concussions. One study showed that each additional pound of neck strength resulted in a 5% reduction in concussions.
  • Rule Changes: Rule changes and enforcement of rules by officials may help to reduce the likelihood of concussions. Recent initiatives in youth sports look promising. These include elimination of checking in ice hockey and heading soccer in younger age groups, and reducing contact in football practice.

I hope you enjoyed my summary of this very informative article. At Sadler Sport Insurance, we have an excellent risk management library on the topic of concussion and brain injury risk management that you should check out.

 

Ban Youth Tackle Football? No Way.

Knee-jerk legislation is NOT based on science

California, Illinois, Maryland and New York recently introduced legislation to ban youth tackle football prior to an unspecified age. These are knee-jerk reactions to concerns over chronic traumatic encephalopathy (CTE). In my opinion, this is ridiculous and based on untested theories, not on current, peer-reviewed, scientific studies.

I try to be one of the few voices of reason in the panicky discussion of concussions and CTE in youth football. The media continually fuels the concussion conversation with emotionally-packed and hyperbolic statements. They do this because it sells and keeps readers/viewers tuned in, which is what their advertisers want. Also, many researchers need for youth tackle football to be “very dangerous” so their funding will continue to pour in.

My message, on the other hand, is the importance of risk management and relying on science. I never downplay the risk of concussions or the seriousness of such injuries. I urge my clients  to pay attention to peer-reviewed scientific research and not pay serious heed to unproven theories backed by anecdotal, non-scientific studies.

A good example is this recent study that found no clinically significant harmful association between playing football in high school and increased cognitive impairment or depression later in life.

New, credible voices being heard

Vindication of my stance can be found in the recent article “Does CTE call for an end to youth tackle football?” In it, 26 brain injury experts from 23 U.S. and Canadian universities and hospitals state what I’ve been saying for years. And they have the science to back it up.

One thing I learned is that CTE presents in approximately 12% of healthy people who died at an average age of 81 years.

The authors make many interesting points on the topic. But their bottom line is that there is no strong scientific evidence that links youth sports to brain injury, brain injury to CTE, and CTE to dementia. They refer to three recent studies published in peer-reviewed journals. None found any increased risk for long-term brain damage in older men who played high school football.

They encourage further research to understand the many different variables involved in CTE and to attempt to isolate participation in youth tackle football.

There’s more to it than tackling

Youth tackle football offers many benefits that factor into character development and good health:

  • Combating the obesity epidemic among youths who may not be interested in Youth sports insuranceplaying any other sport
  • Sparking a lifelong interest in exercise and physical fitness
  • Learning invaluable lessons through sports such as teamwork, sportsmanship and commitment.
  • Trading in unhealthy and unsafe after-school activities by at-risk youth for youth tackle football
  • Role modeling through adult administrators, coaches, and other staff.

And what about the other sports that have high rates of concussions such as hockey, rugby, lacrosse, and soccer? Could it be that politics is playing a role in zeroing in on football?

And why is the government getting involved in making decisions for parents when it comes to participation in youth tackle football?

There are others out there who think the same way I do. These doctors wrote their fact-based article so eloquently that I encourage you to read it in full for yourself.

Mainstream Media Continues to Stir Pot on Youth Football Concussion Risks

It’s time to employ our critical thinking skills

Just prior to the Super Bowl, NBC released its recent survey results on parental concerns about high school football-related concussions. Just know that NBC made a calculated move in doing so. Apparently NBC found it necessary to stir the pot while all’s abuzz about football —  because there aren’t enough alarmist opinions and articles already being pushed by the media on the subject.

The NBC/Wall Street Journal survey polled 900 adults between January 13 and 17. Approximately half those respondents were reached by cell phone,  which makes me wonder who these adults were. I mean, who answers their cell phone when they don’t recognize the caller’s number?
youth football insurance

NBC goes on to report statistics that supposedly prove nearly half of American parents have concussion-related concerns associated with high school football. Well, half those polled don’t have children in their homes. And that causes me to ask how current are they on the research being conducted?

The good news is that 49% apparently see no need to encourage a child to change sports for fear of a football concussion.

But the best news about this is that none of what the NBC/WSJ poll has to offer is credible, scientific research.  

Scientific research on high school football-related concussions

Rather than rely on dubious poll results (which can easily be skewed), let’s see what the science has to say.

Researchers specifically questioned whether an association exists between playing high school football and cognitive impairment and depression in 65-year-olds. The Journal of American Medical Association Neurology published their findings in August 2017.

The study included 3904 men averaging 64.4 years of age (not 900 random people). The cognitive and depression outcomes were found to be similar among those who played high school football and their counterparts who did not play. You can access the article here.

It’s important to remember that JAMA only publishes peer-reviewed articles. This means the quality of the research must pass the review of scholars knowledgeable in the subject area before accepted for publication. I’m not sure how much NBC or the Wall Street Journal actually know about high school-related football head injuries. Their news reports are reviewed by an editor, which is a type of peer-review, but not a scientific or scholarly one.

Don’t believe all the hype

I blog extensively on concussions, in football and other sports. I acknowledge that a concussion can be a serious injury and that CTE is a concern that requires additional research. But I also advocate for best risk management practices to lower the risk of any injury. I also present the facts that almost always contradict the hype stirred up in the mainstream media. The media makes money off the fear and controversy surrounding football-related concussions. It’s in their best interest to keep the conversation going.

What they aren’t talking about

What’s missing from media headlines is that all 50 states and the District of Columbia now have concussion laws on the books. And these laws are constantly being improved upon.Concussions in youth sports

They also don’t put on their front pages the the exponential growth in concussion awareness due to education. National sports associations have adopted brain injury and concussion risk management programs that key in on the essential elements of education, limitation of contact, concussion recognition, removal, and return-to-play protocols.

Parents, coaches, trainers and players are getting the information they need to be informed decision makers. The number of concussions in youth football and other contact sports is not increasing. Concussion awareness now results in more concussions being reported and treated.

For further reading

Below is a list of just a few of the articles from our blog that offer credible information to counter the constant flow of hype. Compare them and their sources to the fear-inducing and hyperbolic news reports like the one published by NBC this week. Draw you own conclusions.
Better yet, we invite you to read this like-minded opinion from a well-respected scientist and member of the scholarly  community.

Sources:

Researchers studying soccer concussions and links to CTE

Science focusing on how many hits, not just how hard

We frequently write about concussion prevention, usually in connection to football. But concussions are a concern in soccer, too, and scientists are turning their attention to the sport.

Most people don’t think of soccer as a contact sport. But repeated player-on-player impacts and headers can result in concussions. Soccer is played by millions of kids at all age levels, so concussion education and research related to prevention is critical.

A good starting point is the U.S. Soccer Federation’s policy that strictly limits headers in youth soccer. Set in 2015, it prohibits players under age 10 from heading the ball and reduces headers during practice for players aged 11 to 13.

Concussions and CTE

Talk of concussions always leads to talk of CTE, or chronic traumatic encephalopathy. CTE is a progressive degenerative brain disease found in people with a history of repetitive brain trauma. It can only be diagnosed by conducting an autopsy. To date, there is no definitive proof that CTE is caused by concussions.

However, research suggests that repeated, less violent sub-concussive hits football and soccer players take may trigger CTE.  Current research being conducted by Michael Lipton, a neuroscientist at the Albert Einstein College of Medicine, is seeking to identify what triggers CTE. His research seeks an answer to the question of how much impact it takes for brain function to be affected.

Measuring the impact scientifically

Lipton hopes to find the answer by tracking about 400 recreational soccer players for Concussions in youth sportsseveral years. The study participants get a brain scan and blood work done. To test cognitive abilities, they participate in brain games on a tablet. Changes in brain function are mapped through diffusion tensor magnetic resonance imaging.

Lipton found in an earlier study of about 37 players that heading the ball is associated with cognitive setbacks and changes to the brain structure. This was the case even when no concussion was diagnosed. Observation of the players revealed that they head the ball an average of six to 12 times each game. These balls are traveling missile-like at speeds up to 50 mph. Players headed balls up to 30 times during practice drills. The study suggests that memory problems set in at about 1,800 headers.

Looking ahead

Conducting such a study on a larger group of players could help researchers find the point at which players should cease playing or back off heading the ball.

Other medical researchers hope to eventually isolate a biomarker that signals the onset CTE. That information would enable players to determine if and when it’s time to hang up their cleats.

In my opinion

I’m a bit confused about Lipton’s research methods. I seriously doubt he will find much heading of the ball in his new study of recreational soccer players. In his earlier study, the number of headers cited per practice seem too high for even the average club-level team. In watching my daughters’ club and high school practices over the past 10 years, I’ve never seen anything close to 30 repetitive header practices with high speed balls. The only heading-specific drills are low speed. The entire team may practice high-speed headers off of corner kicks, but the hits are spread out among the entire team.

You can read further articles about concussions on our blog.

Source: ERIC NIILER, “Brain Trauma Scientists Turn Their Attention to Soccer.” wired.com. 27 July 2017