All parents and athletes must receive information that includes the risk involved with participating in their chosen sport as it pertains to concussions. This pamphlet is to be designed and distributed by the Ohio Department of Health.
All coaches and officials (including HS and MS officials) must attend a course on concussions every three years. They have two options available to them to complete this requirement.
- They may attend a local Pupil Activity (PAP) Permit program that all high school and middle school coaches are already required to attend every three years. This option incurs some costs to the individual that include the application fee to the Ohio Department of Education (currently $45) and whatever fees the provider of the course charge (commonly about $20). As a condition of renewing the permit, HS and MS coaches ALSO have to complete the online program below.
- This PAP can be cost prohibitive to many volunteer parents to coach in their son's or daughter's league. They are required to take a class approved by the Ohio Department of Health (ODOH) which are posted at http://bit.ly/WDPpcU. This list of approved classes is required for ALL coaches and ALL officials.
- It needs to be noted that these non-PAP classes will allow the individual to coach any level of competition that is not sponsored by the Ohio High School Athletic Association (OHSAA). These classes will not substitute for the PAP for HS/MS competition. Any HS/MS coach that does not complete the PAP program is ineligible to sit on the sidelines for competition and risks the school being penalized $250 per incident.
- This can create some problematic scenarios where a healthcare provider may try to clear a person without proper direction in place. This was designed to prevent many alternative medicine persons from trying to act independently and return a kid to play inappropriately. However, the lawmakers did recognize that having a physician attend every practice and game in the state is not only expensive, but also inappropriate. Therefore, the legislature allowed other healthcare providers to have this authority to do so. Most other states designate these other providers as athletic trainers (ATs), physical therapists (PTs), registered nurses (RNs), physicians assistants (PAs), emergency medical technicians (EMTs), etc. Ohio did not want to get caught in the political struggles of these professional groups when writing this law, so they allowed the physicians to decide who is qualified and who is not.
- An interesting point will be that physical therapists are not required to be under the direction of a physician in Ohio any longer. It is possible that a PT (most likely a private practice PT) may try to return a child to play without having a physician contract behind them to do so. This PT would be at serious risk for sanctions if they do so.
- PTs are not the only ones that risk this issue. It is unfortunately very common for off duty nurses and EMTs to wander onto the sidelines during an injury situation. I have had to tell more than one off duty professional that they need to return to their seat and allow me to do my job because they are putting my license at risk. Many people do not trust that anyone else has the education and background to provide appropriate care in an emergency situation, and in particular, athletic trainers. However, even athletic trainers need to have a contract with the team or league and a physician in order to allow then to perform their duties. This can lead to some very sticky situations if the letter of the law is not followed.
- However, there is a provision that allows any organization (OHSAA) to have a more stringent set of rules than this provision in the Ohio Law that defines who is allowed to return a child to play. This law allows the OHSAA to continue to restrict this list of medical professionals to MDs, DOs, and athletic trainers. This can also create a point of contention with other health care providers who may believe that this state law gives them the authority to return a child to play under this law in HS/MS events. It does not allow anything to change at these OHSAA sanctioned events.
The problems with the new law occur when the child participates in multiple leagues or sports or is active at home in unsupervised play. No law could prevent a child from heading out into the back yard with their siblings and neighbors and climbing the jungle gym, jumping on the trampoline, or playing a pick up game of baseball when they shouldn't. This is the sole responsibility of parents and guardians of the child and it must be taken seriously. However, this becomes a bigger problem for volunteer coaches when a child sustains a concussion in a travel baseball practice in the morning or even in some unsupervised activity. The coaches may follow all the rules and do everything properly there so there are no issues. However, if the child then participates in a hockey game that evening and the coaches are unaware of the earlier issue, then you have a major problem. Obviously, the coaches could not be held liable for something they have no knowledge of, but what are the parents'/guardians' responsibilities and liabilities? It is very easy for me to believe that parent would allow a kid to play in the game that evening, especially if it is "important to that season." I see that excuse far too often.
Another problem with the law is that is does NOTHING for the academic issues that a child may face after sustaining a head injury. It is well documented (and should be fairly obvious) that there are often cognitive deficits that occur after a concussion that make schooling significantly more difficult for the child. There is also some research that indicates that continuing to "work through" and not allow for rest and healing from cognitive stresses can increase the length of time that it takes to recover from the injury. It is therefore up to the parents and the school to communicate these issues with each other and to make sure the child appropriately taken care of. There is a large range of accommodations that can be made for these children, but that is the topic of another post.
The last problem that was brought to my attention by a lawyer who tweeted me. He said the trial lawyers are going to have a "field day" with this new law. The "willful and wanton misconduct" clause leaves a lot of room for interpretation by prosecutors and juries to determine whether or not a coach is going to be held liable for a child's injury. While I agree that this is very subjective, I can't think of a better way of doing this.
In conclusion, most interested parties in this this process are happy to see this law pass. The effective date for this will be April 26th, 2013, which happens to coincide with National Athletic Trainers Month. It will be very easy to help promote both the profession and this new law in Ohio when it goes into effect. The Ohio Athletic Trainers Association is already working to promote both ATs and the law and has encouraged their members to share this video to explain the importance of athletic trainers in this process. Of course, this could also bring a large amount of attention to the lack of athletic trainers in schools across Ohio and increase the job market opportunities for ATs.
- For more information on what a concussion is, please refer to this video that was produced by the National Athletic Trainers Association in partnership with the National Hockey League.
