Concussion law hard to enforce

WENATCHEE – 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.

But his tenacity exacted a physical price – 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 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.

“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 had turned the guidelines into law until now.

The concussion law became a crusade for the family of Lystedt and 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 (injury).

“The irony is, of course, it’s not the first concussion, but if you do this right, you can prevent the tragedies, or so we think. That’s what Zack Lystedt was all about.”

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.

“Don’t tell me this is burdensome. What’s burdensome is the Lystedts’ family life,” Herring said. “This is the right thing to do. If it’s a little inconvenient I can live with that.”

Herring said 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 foothills. “That puts a lot of stress and strain and responsibilities on me.”

More than most, Hallead is acutely aware of the impact multiple concussions can cause. He was diagnosed a few years ago with post-concussion syndrome. He estimates that he sustained at least 10 concussions playing high school and college football. He suffered bouts of depression, nausea and blank spots in his memory – all well after his playing career was over.

Still, he’s not entirely happy about the new requirements that call for him to pull a player who exhibits even one symptom. “I think the emphasis is good, but I think it’s a little extreme,” Hallead said. “But I like the emphasis.”

Different concerns come up in rural parts of the state, where emergency medical services are at least an hour away.

“I think it’s a good law. It’s for the kids, and I’m in favor of anything for the kids,” said Dan Oppelt, the athletic director and football coach at Wahluke High School in the farming town of Mattawa.

“But,” he added in the same breath, “it’s going to be difficult to implement and patrol out here in the middle of nowhere.”

Ultimately, the effectiveness of the new law is going to be based on the athletes and their willingness to be open and honest about how they’re feeling in the wake of a hit. Proponents hope as word of more athletes and the fallout from their concussions gets publicized, their peers will be more open to expressing concerns about their injuries. Chase O’Neill missed 46 days of school during her junior year at Sequim High School on the Olympic Peninsula after suffering a pair of concussions during a soccer game. Neither happened because of a particularly hard fall or being hit in the head by the ball.

A year later she can barely do any running, and playing soccer as a senior is out of the question.

Kyle Beltran didn’t understand the seriousness of concussions until football camp this summer. While pulling as a lead blocker, the offensive lineman was blindsided.

“I flipped over and that was it,” Beltran said.

At a summer camp, getting sent to the sidelines was OK. During a game, Beltran said, would be a different story.

“I got hit pretty hard, and if I got dazed I wouldn’t want to be out of the game, but I guess it’s smart safety-wise,” said Beltran, a senior at Highland High School in the small town of Cowiche. “Almost any football player would. I would hide it to a point.”

Beltran’s last sentence is what concerns coaches and administrators.

“What people need to understand is that this is a preventable problem,” Herring said. “Thank goodness for the Lystedt family (and its advocacy), but this is no way to change behavior. We only need one of these.”