Across the United States, each state's Legislators have passed concussion laws for the purpose of protecting our student athletes' health and well-being. The goal of concussion legislation is to protect our youth from potentially devastating or catastrophic brain injuries.
Hawaii Concussion Law ACT 262
Immediate removal from play is to protect the athlete from potentially long term or catastrophic brain injuries.
Immediate removal will not only protect the athlete from further brain injury but also protect themselves and their teammates from other sports injuries.
The adolescent brain is unique, the brain is still developing and is susceptible to Second Impact Syndrome.
Second Impact syndrome has only been reported in adolescents and young adults, ages 13- 24, with the worst outcomes in younger ages.
The cause is thought to be due to an athlete sustaining a subsequent brain injury before they have fully recovered from a previous injury to their brain, such as a concussion.
There is an increase in blood flow to the brain and an uncontrolled increase in intracranial pressure.
Loss of autoregulation of blood flow
Diffuse brain swelling or brain edema
Within a second to minutes, signs of brainstem herniation and failure
While the concussed individual is recovering from a concussion, he or she may be anxious to return to his or her sport, even before they are ready to return. Coaches need to be aware that the Hawaii Concussion Law states that a high school student athlete may start a return to play protocol when he or she is cleared by a licensed health care provider who is trained in concussion management. The return to play protocol is supervised by an athletic trainer in the high school. At the youth age it is best practice to have the athlete go through a return to play play protocol prior to any contact or game activity. Youth coaches or a safety coach may be able to supervise the progression. Included at the end of this module are examples of return to play guidelines for various sports.
Before beginning physical activity in the return to play protocol, the concussed individual must first be back to school full time without any academic adjustments and be symptom free.
Before the concussed individual can proceed to the next step of the protocol, he or she must be symptom free and each step must be separated by a full 24 hours.
Step 3 - Once cleared by a licensed health care provider the concussed indiviual may start light aerobic activity such as stationary bike or walking.
Step 4 - Running in the gym or on the field for 20 minutes, no helmet or other equipment. Example: Two ten-minute moderate pace running with a ten-minute break between
Step 5 - Non-contact training drills in full equipment. Weight training can begin.
Step 6 - Full contact practice or training
Step 7 - Full clearance to competition.
|Gradual Return to Play Protocol|
|Step 1||Cognitive pacing||Return to life|
|Step 2||Academic pacing||Return to school full time without academic adjustments|
|Step 3||Light exercise||
This step cannot begin until the concussed individual is cleared by a Medical Provider for physical activity.
At this point, the concussed individual may begin walking or riding a stationary bike.
|Step 4||Moderate activity||Running in the gym or on the field. No equipment or helmets.|
|Step 5||Sport-specific and non-contact training||Sport specific drills with equipment. Weight training can begin.|
|Step 6||Full contact practice or training|
|Step 7||Play in game|
|Note: Steps 3-7 are supervised by the Athletic Trainer at the high school. Each step is separated for a minimum of 24 hours.|
A gradual return to play protocol should be adapted to the demands of sport the concussed individual is returning to. The sport specific adaptation will help to determine if the concussed student athlete is ready to return to a real life competition.