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Washington state taking tough stand on concussions

September 20, 2009|Tim Booth

WENATCHEE, WASH. — The scrappy hustle Kam Douglass brought to the basketball court was a coach's dream. Diving for loose balls, flustering opponents with his defensive intensity, Douglass made up for his lack of size when defending bigger and stronger players.

The physical price he paid for his tenacity was head injuries. At just 19, the basketball career of the moppy-haired Douglass is over. He sustained an estimated 12 concussions of varying severity in less than two years.

If Douglass' playing career had begun just a few seasons later, his basketball dreams could have been saved by the toughest sports concussion law in the country -- a measure passed by the Washington Legislature this spring.

"I kind of did it to myself. That's why I'm glad they wrote this law," Douglass said. "Kids can't get away with it. This definitely would have saved my career."

The Zackery Lystedt Law requires all athletes under the age of 18 who are suspected of having a concussion to get written consent from a licensed medical provider trained in evaluating concussions before returning to play.

Coaches must receive concussion education, whether at seminars or through approved online material, and parents are required to sign off that they have read and understand the new requirements. The law covers all athletes in Washington high schools and all youth organizations that use public facilities in the state.

Universally, the spirit of the measure is lauded by coaches, administrators and parents.

But there are significant concerns surrounding implementation and policing of a law with no stated penalties, along with questions about small towns having the resources to comply with the measure and doubts about whether athletes will be completely honest about their health. The last factor is especially worrisome at the high school level. Coaches there feel pressures from parents to showcase their children, and from administrators who expect to win.

"I think there have always been those parents or coaches that would pressure someone to go back into a ball game," said Mike Colbrese, director of the Washington Interscholastic Activities Association. "I think it's unfortunate that we have to have legislation to do it, but it's that extra push to fix something that could be easily fixed. We may not be able to prevent that first concussion, but the real danger is the second one and that's the one we're trying to stop."

More than 3.5 million sports-related concussions occur each year in the United States, according to the U.S. Centers for Disease Control and Prevention and the Brain Injury Association of Washington. The CDC has posted guidelines for assessment and treatment of concussions, but no state or administrative body has turned the guidelines into law until now.

The concussion law became a crusade for the family of Lystedt and for Dr. Stan Herring, co-medical director of the Seattle Sports Concussion program. Lystedt became a patient of Herring's in 2006 after the Maple Valley teenager returned to a middle-school football game following a concussion and sustained a life-threatening brain injury.

Lystedt got hurt while making a tackle on Oct. 12, 2006. After sitting out for a while, he returned in the fourth quarter. He collapsed after the game and underwent two emergency brain surgeries.

He remains dependent on a wheelchair and around-the-clock care.

"The problem is you don't know which one is going to be a tragedy. This is the one time you can prevent a tragedy," said Herring, who serves as a team physician for the Seattle Seahawks and Mariners. "You can train all you want, you can't really prevent an ACL tear. You can train all you can, you can't prevent a hamstring."

Herring has spent hours speaking to various groups on the dangers of youth concussions. He says young brains have unique vulnerabilities that make concussion recovery longer, and the risks associated with multiple concussions within a short period extremely dangerous.

That's why Herring, who advised lawmakers as they drafted the law, was so adamant that someone trained in concussion management must be the one to sign off on letting an athlete return to action, even if it can cause hassles for athletes in many of the small towns dotting the state that have limited health services.

Herring says a coach's job, under the new requirements, is "to understand what a concussion can look like." Yet some coaches aren't comfortable trying to diagnose such an injury.

"Not having an athletic trainer, not having a doctor on the sidelines, I'm the first response guy and I'm a head coach," said John Hallead at Onalaska High School in the Cascade Mountain foothills. "That puts a lot of stress and strain and responsibilities on me."

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