According to the Centers for Disease Control and Prevention (CDC), concussions are one of the most commonly reported injuries in children and adolescents who participate in sports and recreational activities. Their data estimates that as many as 3,900,000 sports-related and recreation-related concussions occur in the United States each year.1 At the same time, the effects of concussions on National Football League(NFL) pro football players have received much press this season. In just one weekend this past December, Green Bay Packers quarterback, Aaron Rodgers; Pittsburgh Steelers tight end, Heath Miller; Arizona Cardinals quarterback, Derek Anderson; and Indianapolis Colts wide receiver, Austin Collie were all in the news after being sidelined due to concussions. According to NFL data obtained by the Associated Press, the number of concussions being reported this season is up more than 20 percent from 2009, and more than 30 percent from 2008.2

 

What is a Concussion?

A concussion is caused by a blow or motion to the head or body that causes the brain to move rapidly inside the skull. A concussion is a mild form of traumatic brain injury. The risk of catastrophic injuries or death can be significant especially in youth athletes when a concussion or head injury is not properly evaluated or managed.

 

Who is Zackery Lystedt and Why Is a Law Named for Him?

Zackery is a young athlete from the state of Washington. Three years ago, while playing football for his middle-school team, Zack’s head hit the ground late in the first half of a game. He grabbed his helmet in obvious pain as he struggled to get up. He made it to the sideline, sat out for about fifteen minutes, and then went back in the game after half time. Zack continued to have symptoms from his first blow, and took other blows to his head in the second half of the game. On the last play of the game, Zack was involved in another tackle, this time forcing a fumble on the goal line to save the game. Zack collapsed in his father’s arms when the game ended, suffering a life-threatening brain hemorrhage that resulted in the removal of both sides of his cranium. He was in and out of a coma for almost three months. In the three years since Zackery was injured, his family’s focus has been two-fold: helping Zack heal, and preventing others from suffering a similar fate. Their goal has been to encourage states to enact laws requiring that athletes under the age of eighteen who are suspected of having sustained a concussion are removed from practice or a game — and not allowed to return until they have obtained a written return-to-play authorization from a medical professional trained in the diagnosis and management of concussions.

 
Zack’s family sought out experts and advocates in Washington state to assist with their mission. One key supporter they recruited was Stanley A. Herring, MD. Dr. Herring is a team physician for the Seattle Seahawks and Seattle Mariners, and is co-medical director of the Seattle Sports Concussion Program. Further, he serves as a member of the NFL’s Head, Neck and Spine Medical Committee. Dr. Herring recalls the first time he met Zack: ". . . He was seated in his wheelchair with his father by his side. He looked me straight in the eye and very slowly and deliberately said, ‘The reason I’m here is to help people.’ Perhaps because he couldn’t speak for nine months, or because he almost lost his life and has had to work so hard to regain any sense of normalcy, I knew how incredible that statement was, coming from him. He doesn’t mince words, and everyone is a friend. He’s had choices along the way — anger or contentment, depression or acceptance, bitterness [or] peace. Each choice, each fork in the road, has made him who he is today: the driven, witty, fabulous seventeen-year-old young man who, along with his family, is changing the face of youth sports today."3
 
Through their efforts, and under the leadership of attorney Richard Adler, then-president of the Brain Injury Association of Washington, and others, Washington state adopted the Zackery Lystedt Law, which became effective in July 2009. Athletes under the age of eighteen who are suspected of having sustained a concussion are removed from practice or a game — and are not allowed to return — until they have obtained a written return-to-play authorization from a medical professional trained in the diagnosis and management of concussions. The law also stipulates that parents and athletes must read and sign a head injury information sheet annually. School districts are required to work with the Washington Interscholastic Activities Association to develop guidelines for safe play, and private nonprofit youth leagues must comply as well. (Visit www.tbiwashington.org/tbi_wa/bill1824.shtml for more information about the Lystedt Law.) View the CBS video of Zackery’s story at www.cbsnews.com/video/watch/?id=5014944n&tag=api.

 

A Coalition to Advocate for Zackery Lystedt Laws in Every State

In 2009, The American College of Sports Medicine (ACSM), the world’s largest sports science and medicine professional organization, demonstrated their commitment to sports and recreation safety by issuing a national call to action for Lystedt Laws to be passed in every state and the District of Columbia. The NFL has joined in these advocacy efforts. In October 2010, NFL Commissioner Goodell spoke at the "Keep Youth Sports Safe" conference at the Seattle Seahawks’ offices. At the conference, Commissioner Goodell met Zack Lystedt and his family and committed that the league will continue to support promotion and adoption of the Lystedt Law until all fifty states pass Zackery’s law, or take action to keep youth sports safe from the risks of concussion. Watch a video of the commissioner’s speech at: www.nflhealthandsafety.com/media/videos/#promoting-safety-in-youth-sports. Read the commissioner’s letter to state governors at: www.nflhealthandsafety.com/pdf/NJGovernorLetterRG-508.pdf.

 

Progress in Other Sites

As of October 2010, eight other states have adopted laws similar to the Zackery Lystedt Law — Oregon, New Jersey, New Mexico, Connecticut, Oklahoma, Virginia, Massachusetts, and Rhode Island. In many other states, active coalitions are advocating to enact similar legislation.

 

Application to the Camp Community 

While camp programs are generally not held to the requirements of these state concussion laws (unless they conduct a youth sports program, such as a soccer or football camp), the practices and safety measures contained within them are still important to consider.
The American Camp Association’s (ACA’s) Healthy Camp Study Impact Report 2011, indicated that 23.6 percent of injuries to campers and 18.5 percent of injuries to staff were in the head/ face/neck region of the body.4 Prevention of head injuries is such a critical issue that ACA standards for accredited camps require helmets to be worn for all participants participating in:
 
  • Activities involving any kind of motorized vehicle
  • Activities involving boarding, in-line skating, and hockey   
  • Adventure/challenge activities that involve rock climbing, rappelling, spelunking, high ropes (including zip lines), or vertical climbing walls/towers
  • All horseback riding activities, including pony rides
  • Bicycling
 
Prevention, however, is just the first step. It is important that your camp health care and medical staff:

 

  • Understand how to recognize and evaluate a camper with a concussion

  • Understand how to manage and treat a camper with a concussion (in partnership with parents)
  • Develop policies and procedures regarding when a camper can return to camp activities  
 

Resources

The NFL, the CDC, and a number of other organizations have partnered to create concussion awareness, prevention, and return-to-play materials for youth sports organizations. While not specific to the camp community, their recommendations can assist your camp in creating a culture where head injuries are minimized; where accidents involving head injuries are evaluated and handled by professionals trained in the diagnosis and management of concussions; and return-to-activity decisions are made by those medical professionals in partnership with parents.
 
For more information and resources regarding this issue:

CDC

  • Learn to Prevent and Recognize Concussions: http://www .cdc.gov/Features/Concussion/
  • Heads Up — Concussions in Youth Sports Toolkit: http://www.cdc.gov/concussion/HeadsUp/youth.html

    This resource includes:

    • Fact sheet for coaches (useful for camp staff)
    • Fact sheet for athletes (useful for campers)
    • Fact sheet for parents
  • Toolkit on Concussions for Team Physicians: http://www .cdc.gov/concussion/HeadsUp/physicians_tool_kit.html (useful for camp doctors and medical staff)
 

ACSM

 

This resource is a consensus statement of ACSM, the American Academy of Family Physicians, the American Academy of Orthopaedic Surgeons, the American Medical Society for Sports Medicine, the American Orthopaedic Society for Sports Medicine, and the American Osteopathic Academy of Sports Medicine.    AA   AA   

 

 

American Academy of Pediatrics (AAP)

 

 
Notes
1. Centers for Disease Control and Prevention. (2008). Heads up: Concussion in youth sports. Retrieved from www.cdc.gov/concussion/pdf/ Heads_Up_Activity_Report_Final-a.pdf
2. Waszak, Jr., D., Lage, L., Booth, T., Dubow, J., and Jenkins, C. (2010, Dec. 13). NFL concussion reports up this season. Associated Press.
3. SportsConcussions.org (2010). WA state’s inspiration for a comprehensive concussion law. Retrieved from www.sportsconcussions.org
4. American Camp Association. (2011).The healthy camps study impact report.
 
ACA wishes to thank Dr. Stanley A. Herring for his assistance in the development of this article. Dr. Herring is a team physician for the Seattle Seahawks and Seattle Mariners, and is co-medical director of the Seattle Sports Concussion Program. Further, he serves as a member of the NFL’s Head, Neck and Spine Medical Committee. He was instrumental in the adoption of the Zackery Lystedt Law in the state of Washington.

 

The views and opinions expressed by contributors are their own and do not necessarily reflect the views of the American Camp Association or ACA employees.

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