Archive for the ‘Concussion’ Category

AAP Makes Safety Recommendations for Youth Tackle Football

American Academy of Pediatrics says no need to delay teaching of proper tackling techniques to younger age groups

The American Academy of Pediatrics is tackling the issue of safety in youth football with new recommendations published in this month’s issue of Pediatrics. The AAP statement is a result of research on football injuries, head and neck injuries in particular, and the connection between tackling to football-related injuries.

The main points of the AAP recommendations are:

  • Enforcement of proper tackling methods by officials and coaches, i.e. not tolerating head-first tackles.
  • Informing players about the benefits of play vs. potential risk of injury.
  • Offering more players opportunities to play through expansion of non-tackle leagues.
  • Putting athletic trainers on the field to assist in preventing injuries.

No perfect answers to safety risks

The removal or delay of introducing tackling are ideas that get floated regularly. According to Greg Landry, co-author of AAP’s recommendation statement, delaying the tackling experience until players are older and stronger could actually result in higher injury rates. The AAP would not go so far as to recommend removing tackling from youth football. Doing so would “dramatically reduce the risk of serious injuries to players, but it would fundamentally change the sport,” said William Meehan, III, a co-author of the statement.

The AAP stance is that proper tackling techniques should be taught early, even if tackling isn’t incorporated into the game. The AAP also encourages reducing the impact to players’ heads through ongoing coach instruction in proper tackling methods.

Tackle football is played by nearly 1.1 million high school players and consistently ranks as one of the most popular sports for youth athletes. There are untold millions  more ranging from 5 to 15 years of age playing in youth leagues.

In my opinion

These common sense recommendations help to restore balance when so many are trying to stir the pot and predict the “end of football” for their self serving interests. The bottom line is that all sports and recreational activities involve risks, but in most cases, the benefits outweigh the risks. I do question whether youth leagues can afford to have athletic trainers on the sidelines at every practice.


Source: “The American Academy of Pediatrics Tackles Youth Football Injuries.” aap.org. 25 Oct. 2015.

IL High School Assn. Concussion Class-action Lawsuit Dismissed

Judge uses head in rendering decision

An Illinois concussion class-action lawsuit, which is the first concussion class action against a state high school association, has been dismissed. The suit was filed by players against the Illinois High School Association. The judge ruled that IHSA has put policies in place to improve the safety of the game and minimize brain injury risks. Judge Leroy Martin, Jr. also stated that mandating costly requirements would only cause football to be unaffordable for many schools.

The judge recognized IHSA’s efforts to protect student athletes, and that it has no direct relationship to football or the plaintiffs. In addition, his written decision read in part, “Imposing broader liability on this defendant would certainly change the sport of football and potentially harm it or cause it to be abandoned.”

The suit against the IHSA is the first of its kind against an organization overseeing high school football. The plaintiffs were asking the court to supervise high school management of football head injuries and seeking payment for medical testing of former students who played from as far back as 2002. The suit’s lead plaintiff played from 2010 to 2014 and states he continues to suffer memory loss from injuries suffered during that time.

The arguments

IHSA argued that it’s not an NFL-like cash cow and has an annual revenue of only $10 million to cover over 40 sports and other activities among the state’s high schools. There would be no room in the budget to comply with any requirements imposed by the court, according Thomas Heiden, the attorney representing IHSA.  He also argued that covering the payment the plaintiffs requested would lead to poorer schools shutting down their football programs and leaving only the students in wealthy schools eligible to participate.

According to plaintiffs’ attorney Joe Siprut, IHSA was giving the false notion that high school football is being threatened, and that improved safety would lead to its survival. He argued that the sport is already in danger since many fearful parents are not allowing their students to play.

In my opinion

This is a common sense ruling that may help to restore some balance against the media and research group-induced paranoia that evidently needs youth and high school football to be very dangerous to serve their interests. But, of course, this is just a trial court ruling and we probably have not seen the last of these. The good news is that the educational outreach programs and new risk management protocols seem to be having a positive impact.


Source: Michael Tarm and Sara Burnett, “Judge Tosses Concussions Lawsuit,” insurancejournal.com. 20 Oct., 2015.

Immediate Sideline Detection of Concussion

Vision test is new tool for concussion detection

The estimated 4 million sports-related concussions that occur nationwide every year are getting lots of attention from the media and medical professionals. And it looks like scientists have come up with a simple and reliable test to quickly determine on the sidelines whether or not an athlete has sustained a concussion.

Results of the study

The King-Devick vision test measures how rapidly athletes can read a series of numbers. Studies revealed 86 percent reliability in detecting concussions in athletes to whom the tests were administered. The determinations were later clinically confirmed. When the vision test was administered along with balance and cognition assessments, detection of concussions was 100 percent.

The New York University Langone Concussion Center review included 1,419 pro hockey players and amateur, college and youth football, hockey basketball, rugby, boxing, soccer, and lacrosse players. Concussions were sustained by 112 of the participants.

Vision plays an important role in the diagnosis of concussions and their potential long term effects. There is a vast network of visual pathways in the brain, and disruptions in these pathways can be a sign of a brain injury. Earlier studies using the rapid number reading tests show a correlation between lowered scores and other neurological conditions such as multiple sclerosis,  ALS, and Parkinson’s disease.

Sideline administration

Coaches can administer baseline testing on athletes before the season starts to be used for comparison in the event of a suspected concussion. Uninjured athletes tend to improve their reading time by 1.9 seconds later in the season, while those tested immediately after sustaining a concussion averaged 4.8 seconds longer than their baseline times.

Subscriptions to the King-Devick vision test kits are currently available for $20 per athlete, which includes unlimited screenings throughout the subscription year.

Only a medical professional should diagnose a concussion.  But since there isn’t always a physician on the field, the King-Devick vision test is an effective tool to help parents, coaches, and trainers on the sidelines determine if an athlete should be removed from play, according Laura Balcer, co-director of the Langone Concussion Center and a professor of neurology.

There can be a lot of chaos on the sidelines, so anything that helps eliminate guesswork is needed, said Steven Galetta, co-author of the study, which was published in the September, 2015 issues of Concussion.

We have more information on concussions and concussion prevention on our blog.


Source: “Vision testing effective for concussion detection,” Sporting Kid Live, nays.org. 11 Sept, 2015.

USA|Heads Up Football Imposes Onerous Contractual Requirements on Leagues

Shifts responsibility to leagues to pay for concussion lawsuits arising out of Heads Up course content and instruction

USA Football (USAFB), the governing body of youth football and potential deep pocket target in future lawsuits involving brain injury and concussions, has imposed onerous contractual requirements on member leagues that have adopted USAFB’s Heads Up Football (HUF) tackle training course. The potential effect of these contractual requirements is to shift the responsibility to pay for brain injury lawsuits away from USAFB/HUF and to the leagues in cases where both parties are named as defendants in a lawsuit.

Read fine the print for objectionable insurance and indemnification/hold harmless provisions

Prior to being able to access the 2015 HUF training course, leagues must first sign an 8-page contract with USAFB which includes objectionable sections dealing with both insurance requirements and hold harmless/indemnification transfer of liability. This is a classic example of “risk transfer 101” where the party in power imposes its superior strength and bargaining power on the weaker party. Furthermore, in this case, the party that is being shielded (USAFB|HUF) is providing a high-risk service that could be a lightning rod for potential litigation.

Without getting deep into the technicalities, to follow is a brief summary of the objections:

 The insurance requirements section is worded to require the league to name USAFB|HUF as an additional insured under the league’s General Liability policy and furthermore states that the league’s insurance is to be primary to USAFB|HUF’s policy. The intent appears to be to shift the responsibility to pay for legal defense and settlement from USAFB|HUF’s insurance carrier to the league’s insurance carrier in cases where negligence is alleged against both parties.

 The indemnification/hold harmless provision requires the league to assume the liability of USAFB|HUF in the event that the league breaches or defaults on any one of the 10 member obligations when implementing the HUF program. Leagues that can’t prove that they have implemented all 10 requirements may unknowingly be assuming liability that would normally belong to USAFB|HUF.

Complaints by leagues, insurance carriers, insurance agents

These requirements have resulted in numerous complaints by local leagues, national youth football sanctioning bodies, and insurance agents and carriers that specialize in this niche. At least one prominent insurance carrier that serves the sports niche has refused to comply with the additional insured requirement for many of its clients.

Example of how many brain injury lawsuits may play out

Any concussion/brain injury lawsuit filed by an injured player is likely to name multiple defendants including the league and its directors, officers, and staff as well as the vendor that provided the tackle training instruction, i.e. USA Football|Heads Up Football. Under the legal theory of contributory negligence, for example, the league may be found to be 50% negligent (for negligent supervision and instruction) and USAFB|HUF may be found to be 50% negligent (for negligent course content and instruction).

Normally in such cases the insurance carriers of both parties would pay for the respective parties’ own legal defense and the court apportioned negligence percentage of settlement or adverse jury verdict costs. However, with the addition of the objectionable insurance requirements and indemnification/hold harmless provision, it is feared that the outcome would be altered so that the league would be responsible to pay for all of USAFB|HUF’s legal defense and settlement costs. In other words, the league could be responsible to pay for 100% of all legal defense costs and settlement costs for both parties. At least that is the opinion of several experienced and reputable insurance and risk management experts who have reviewed the terms of the contract.

4 reasons why the objectionable requirements are unfair and detrimental to leagues, insurance carriers, and youth tackle football as a whole

  1.  In cases where both the league and USAFB|HUF are named in a lawsuit, the General Liability insurance carrier of USAFB|HUF should be responsible for paying for its own legal defense and any settlement or adverse jury verdict costs to the extent that a court apportions negligence to USAFB|HUF.  USAFB|HUF should have enough confidence in its own course content and instruction to be willing to assume the risks of its own negligence.
  2. The insurance requirement is backwards in that it should be the league that requests USAFB|HUF to issue a certificate evidencing that it carries $1,000,000 in General Liability and in naming the league as “additional insured.” After all, USAFB|HUF is the vendor that is providing the high-risk service in exchange for a fee. Leagues should require all their vendors to provide such insurance protection including umpire crews, concessions, field maintenance, janitorial, fireworks, etc., instead of the other way around, as is the case here.
  3. Any time a league names another party as an additional insured, the league is sharing its limits with the additional insured. This results in a reduction of limits available to the league and its directors, officers, employees, and volunteers. In a situation where a vendor is providing a high-risk service, additional insured status should only be granted when absolutely necessary to protect an additional insured against the sole negligence of the league.
  4. By deflecting the claims to the local leagues and their carriers, USAFB|HUF could be damaging the leagues’ loss records and jeopardizing their access to affordable insurance or any insurance in the future. In the relatively small niche of youth tackle football insurance, adverse claims history can quickly snowball and impact the few underwriters of this coverage.

Leagues should demand that USAFB | HUF amend the contract

Leagues should demand a more equitable contract with amended insurance requirements and an indemnification/hold harmless provision that restores fairness to the equation. In cases where negligence is alleged against both parties, each party should be responsible for its own negligence. One acceptable solution would be alter the current contract to drop the additional insured requirement and the indemnification/hold harmless obligation on the part of the league should not be triggered by failure to comply with all 10 of the member obligations.

Recent discussions with USAFB over these concerns have resulted in incremental improvements for our American Youth Football clients; however, the provisions are still troublesome in my opinion.

USAFB|HUF should be commended on its development and implementation of the Heads Up tackle training program. However, leagues should think twice about signing the contract as it now exists.

John Sadler

Balancing the Concussion Hype

Looking at both sides of the sensationalism

Over the past few years, the media has kept concussions, particularly with respect to football, in the headlines – some would argue ad nauseum. But the truth is, the press attention and research into causes, long-term effects and prevention is provoking both good and bad outcomes.

The best outcome is the awareness being brought to the general public about diagnosis, second-impact syndrome, removal, and return-to-play policies. Players who have been clocked are no longer being told to “just suck it up.” There are now concussion laws on the books in all 50 states and the District of Columbia and required concussion training for youth coaches and athletic trainers.

However, there is definitely a downside to the hysteria, according to Rance A. Boren, a Texas neurologist. “The notion that everyone who plays football going to be mentally unstable in 15 years is just not true,” he said.

Boren points out that the majority of sports concussion research has focused on professional and college level athletes, not high school athletes. This generally points to the number of hits a player sustains over a period of time, as opposed to the force of a few hits. A player with a decade-long professional career preceded by four years of college ball who likely also played youth football is an example of someone at risk for the long-term injuries frequently seen in the media. The kid who started playing football at 12 and stopped after three or four years of high school ball is hardly ever in that risk category.

It’s important to understand that CTE is not a risk associated with young football athletes –  only a small fraction of NFL and college players exhibit its effects.  CTE is not caused by a single or even multiple concussions that have been properly treated. The word chronic in CTE means the trauma resulted from multiple sub-concussive brain injuries sustained over a long period of time. CTE is usually something boxers or NFL linemen might experience after sustaining thousands of blows to the head over the course of their careers.

However, second-impact syndrome and unreported concussions resulting in subsequent injuries are more common at the high school level. Susceptibility to second-impact syndrome is biological. Boren explains that “metabolic buffering syntheses” haven’t been able to reset. So if you are hit again during that short period between an initial hit and recovery, then you are going to do more damage. If you are then hit again, then you do even more damage.”

It’s for this reason that the University Interscholastic League instituted a 10-day return-to-play rule. The 10-day period begins after all symptoms of concussion have subsided. Returning to play too soon can affect reaction time and vision, which leaves players vulnerable to other injuries.

We invite you to read our many articles on concussions and concussions relating to football


Source: Travis M. Smith, “Concussions: A headache of a problem,” brownwoodbulletin.com. 23 June, 2015.

 

 

Soccer-related concussions

Research looks at player collisions vs heading the ball

While the concussion hype focuses primarily around football, there’s also a lot of discussion about soccer-related head injuries. The soccer concussion debate centers around the question of whether or not a ban in youth soccer on heading the ball and other rule changes would impact the number of head injuries, particularly concussions.

A recent study published in the Journal of the American Medical Association’s JAMA Pediatrics shows that physical contact between players is the most common cause of soccer concussions. In that case, a change in soccer rules about using the head to hit the ball would likely have little effect on concussion rates.

This results of the study conducted by the Colorado School of Public Health were based on data collected from 100 high schools between 2005 and 2014. Researchers documented 627 concussions among girls and 442 among boys, which aligns with past findings that soccer is the second-leading cause of concussions for female high-school athletes and the fifth for boys.

Differing views

Better rule enforcement and continual re-emphasis on the technical skills of passing and dribbling make the game safer, according to the study’s author, Sarah Fields, an associate professor at the University of Colorado-Denver.  FIFA rules only allow for shoulder-to-shoulder contact among players, which Fields thinks should be more strictly enforced.

Not everyone thinks that minimizing rough play is the answer. One of those is Dr. Robert Cantu, a neurology professor at Boston University School of Medicine. Cantu says that most injuries to soccer players under his care that took place when heading the ball didn’t occur during intentionally rough plays. Instead, players were intent on heading the ball and collided with other players intent on the same thing or who got in the way.

While Cantu does not support eliminating heading the ball in soccer, he does recommend banning it for players under the age of 14, stating that’s the age level at most risk for concussion.

Another point in the ongoing debate is that even shoulder level contact can result in concussive forces, whether through direct contact or when a player subsequently hits the ground.

The number of football-related deaths and serious head injuries among high school players in recent years resulted in the concussion laws for all sports being enacted in all 50 states and the District of Columbia.

We encourage further reading of our articles on concussions.


Source: Amrith  Ramkumar, “Injury study spurs debate on soccer-related concussions.” charlotteobserver.com. 31 July 2015.

Innovative sports equipment and safety regulations

Weeding through the hype

There’s an abundance of sports equipment manufacturers coming up with innovative products intended to make contact sports safer. The ongoing concern about concussions, particularly among youth athletes, is a focus and big money maker for many of these manufacturers.

As Eric Berman, an advertising and antitrust attorney, points out in a recent article, manufacturers compete for a share in the market by advertising their products’ safety features. However, the claims made by advertisers and marketers and the science they use to bolster those claims will be scrutinized by both regulators and consumers. Berman’s article discusses the false advertising claims recently being denied by a federal judge in the Riddell Revolution helmet case.

Riddell may have prevailed, but manufacturers will be held to the FTC’s new stringent test data retention requirements. It’s important that advertiser claims are supported by science and that all the documented data, test protocols and records for the clinical studies are maintained.

All that is well and good, but the best way to lower the risk of concussions and other sports-related injuries is through risk management and proper technique training based on credible scientific research. We encourage you to read some of our many articles advocating for risk management policies and concussion education. A perfect example is the Seattle Seahawks’ tackling video, which was released in 2014 as a way to educate coaches and players about their team’s methods of tackling.

Don’t count on technology to provide the safety you can achieve using common sense and proven methods.

Attorneys Soliciting Concussed High School Football Players

A profile of the perfect client for attorneys

We recently came across an article published by a law firm seeking to educate (and solicit) readers about high school football players filing lawsuits against their school after suffering a concussion.

Here are the points that can trigger a successful lawsuit according to the law firm:

  • Athlete was not removed from the field as soon as concussion symptoms were observed
  • Athlete was not evaluated by a medical professional and returned to play, and/or
  • Athlete received medical treatment but returned to play without written clearance by the evaluating medical professional, or
  • Athlete’s coach did not receive concussion management training prior to the injury.

Avoiding lawsuits through risk management

All 50 states and the District of Columbia have passed concussion laws that pertain to high school athletes. The goal of the laws is to prevent concussions from happening and to reduce the risk of long-term consequences. These laws require school districts to develop policies concerning athletes suffering concussions or traumatic brain injuries during school-related activities.

In addition, the National Federation of State High School Associations (NFHS) has published recommended guidelines for concussion and brain injury risk management.

The various state laws and the NFHS recommended guidelines cover all the areas of concern listed in the profile of the perfect client for attorneys. It’s simple: follow the rules that are the standard of care and avoid most of the real liability potential. Ignore the rules or halfheartedly enforce them and you will dilute the strength of your legal defense.

We have more concussion-related information, including the signs and symptoms of concussion.

Source: “Brain Injury Lawsuits and High School Athletes,” jdsupra.com, 24 Feb. 2015.

Football Leagues Ignoring Brain Injury Standards…

do so at their own peril

If your youth tackle football league and its directors, officers, and coaches are sued as a result of a brain injury to a current or past participant, under what standard of care will you be judged?

The law of negligence is based on four elements:

  1. Duty is owed to act as reasonable and prudent youth tackle football and cheer administrators and coaches by following the national standard of care regarding to concussion/brain injury protection.
  2. Duty is breached by not following the national standard of care.
  3. The breach is the cause of the injury.
  4. Damages result.

 As regards the standard of care, the courts will look to expert witnesses who will testify that the standards of care are set by the recommendations of the governing body (USA Football), National Federation of State High School Associations (NFHS), and state concussion laws.football insurance

We have designed a concussion/brain injury risk management program for our American Youth Football and Cheer (AYF) clients that addresses most of the standards that have been set by these organizations and state legislation. See our Football/Cheer Concussion Awareness Risk Management Program (short form) in our risk management library.

If you want to see how standards work in an actual brain injury litigation case, see the synopsis and summary of the pending Chernach vs. Pop Warner lawsuit by a law firm specializing in brain injury litigation. Ask yourself how you think your local association would fare in its legal defense if a similar claim were to be filed? In my opinion, most of the allegations in this lawsuit seem to be without merit, though legal defense costs will be high. Very few of the concussion standards were in place at the time of the alleged injury and the plaintiff was exposed to high school football and 12 years of wrestling in addition to youth tackle football.

However, concussion/brain injury standards are certainly in place now. Ignore the standards at your own peril.

State Concussion Laws

Review of 51 laws highlights protection gaps

The NFL helped bring about the most positive concussion news in recent years by helping all 50 states and the District of Columbia to pass laws aimed at protecting youth athletes from head injuries. But many are now asking if those laws carry enough weight.

Concussion laws

A recent review by the Associated Press of the 51 concussion laws found that approximately 33 percent made no reference to any ages or grade levels covered. Even fewer make explicit reference to both interscholastic sports and recreation leagues. Some state laws clearly cover public and private schools, some only reference public schools, and others lack any such wording. And any mention of penalties for non-compliant schools and leagues is absent in nearly all.

Missing the mark of the original goal

Washington state passed the first concussion law in 2009. That law calls for coach education on concussion symptoms, removing players from games for suspected head injuries,  return-to-play clearance, and required parent/player signed concussion information forms.

The AP review found that only 21 of the laws include all four of the required components in Washington’s bill, which served as the  model for other states’ legislation. Laws in only 34 states mandate return to play/practice only upon written clearance by a health care provider trained in the evaluation and management of concussions. And only 30 require concussion information forms be signed by athletes and their parent/guardian.

Headline media coverage of concussion issues resulted in states passing concussion laws quickly. However, concerns about the cost of enforcing the laws resulted in many being ultimately weaker than originally intended, according to Jay Rodne, a Washington state representative who sponsored the original bill.

Where things stand

The NFL admits that in some states compromises were made in some states to get laws on the books. This resulted in “A ‘B’-level law, as opposed to an ‘A’-level law,” according to Jeff Miller of the  NFL’s health and safety policy. It’s always possible to go back and amend the laws, said Miller. He points out that the passage of these laws has resulted in a growing awareness of concussion safety protocols and risk management among players, parents, coaches, and team/league administrators and concussion treatment.

We invite you to read more of our articles on concussion risk management and research.


Source:  Howard Fendrich and Eddie Pells, “Youth Concussion Laws Pushed By NFL Are Not Enough.” www.huffingtonpost.com. 28 Jan. 2015.