Apr 26, 2010 9:24:56 AM

The NCAA Committee on Competitive Safeguards and Medical Aspects of Sports is recommending legislation to require institutions have a plan on file to respond to student-athletes with a possible concussion and outline who has the authority to provide subsequent clearance.

Reacting to the ongoing review of research data and an April 9 summit of physicians and certified athletic trainers from all three NCAA divisions who discussed concussion-management practices, the competitive-safeguards committee wants to require every NCAA institution to develop and maintain a concussion-management plan. 

The proposed legislation would stipulate that student-athletes who exhibit "signs, symptoms or behaviors consistent with a concussion to be removed from practice or competition and evaluated by an athletics health-care provider with experience in the evaluation and management of concussions."

Further, any student-athlete diagnosed with a concussion would not be able to compete or participate in other physical activity for the remainder of that day, with subsequent medical clearance determined by the team physician or the physician's designee.

"The cornerstone to the plan is that student-athletes have access to athletics healthcare providers with experience in the evaluation and management of concussions and that those providers have the unchallengeable authority to make medical return-to-play decisions independent of the coaching staff influence," said competitive-safeguards committee chair Debra Runkle, the medical coordinator/assistant director of athletics/head athletic trainer at Dubuque. "Coaches and officials should be prepared to recognize and refer upon suspension of a concussion. If a student-athlete is diagnosed with a concussion, he or she may not return to activity for the remainder of that day. Return to play should be with the approval of a team physician or the physician's designee."

The NCAA Executive Committee will review the recommendation Thursday. Endorsement there could result in several outcomes: an immediate resolution, the proposal being forwarded to each division's governance cycle or a subcommittee being formed to review the concepts further.

Runkle said it is critical that action be taken to ensure student-athletes who exhibit symptoms of a concussion are medically managed and that clearance-to-play determination is placed in the hands of the people most qualified to make those decisions.

The recommendation is in line with guiding principles outlined in a 2008 consensus document on concussion management from an international meeting of experts in Zurich. That session found that athletes diagnosed with a concussion should not return for the remainder of the day but left open a window for some adults or elite athletes to return under special circumstances.

"Based on additional discussions, the NCAA believes that limiting the return to activity on the same day is appropriate for the age group within the collegiate setting and errs on the side of student-athlete well-being and academic success," Runkle said.

In addition to the legislative recommendation, the competitive-safeguards committee is also suggesting that language be added to the NCAA Student-Athlete Statement requiring student-athletes to accept the responsibility for reporting their injuries and illnesses, including signs and symptoms of concussions, to institutional medical staff. 

The committee also asked NCAA staff to develop an all-sport educational video on concussions that targets both student-athletes and coaches. That video could be used annually by institutions during formal education sessions. Staff also is being asked to conduct a webinar before the start of fall-sport preseasons for athletics health-care providers, focusing on best practices in concussion-management plans and continuing education for medical professionals.

"We believe each of these steps combine to provide a package of precautions that place a premium on the safety and well-being of student-athletes," Runkle said. "These actions are based on thoughtful feedback and deliberation we have sought from dozens of experts in the field over the past several months."

The effort to address concussion-management policies more broadly began in December with the competitive-safeguard committee's revision of an NCAA Sports Medicine Handbook guideline advising member institutions on appropriate response to concussions and procedures for returning student-athletes to competition or practice.

In January, the NCAA Playing Rules Oversight Panel instructed playing-rules committees to review policies for stopping play for injuries and to consider rules that may further prevent head injuries.

In response, the NCAA Football Rules Committee modified that sport's rules to require removing from play student-athletes suffering any injury (including exhibiting signs of concussion) until cleared to return by appropriate medical professionals, and the Men's and Women's Soccer Rules Committee modified rules to stop the clock and summon medical personnel onto the field in response to signs of concussion, may be substituted for without being charged a substitution and may not re-enter without medical clearance.

The April 9 summit – also an outcome of the competitive-safeguards committee's December meeting – explored emerging trends in medical management of concussions and sought to develop a consensus on best practices for responding to such injuries. These best practices will be distributed to the membership to augment the current NCAA Sports Medicine Handbook guideline on concussions. NCAA members can find new educational materials for student-athletes and coaches online at www.ncaa.org/health-safety.

RECENT BACKGROUND

February 23
New data suggest shift in football concussions rate
Injury data influencing sport-safety discussions

January 13
Rules panel supports concussion concepts

December 10
NCAA panel to review concussion issues
Q&A with NCAA competitive-safeguards committee chair
NCAA changes to minimize risk of injury
NCAA-related concussion studies and articles