Why is there a concussion law in Hawaii and what is second impact syndrome?

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.


What is Hawaii Concussion Law?

Hawaii Concussion Law ACT 262

  • Education of parents, athletes, school staff and administrators and sport officials
  • Includes youth sports from 11 years old and above.
  • Annual training of coaches and athletic trainers
  • Mandatory immediate removal of the athlete when a concussion is suspected
  • Need for clearance to return to play by a licensed health care provider trained in concussion management
  • Return to learn and gradual return to play protocols
  • Funding for high school neurocognitive testing.

Why immediate removal and what are the risks if a student athlete plays with a concussion?

Immediate removal from play is to protect the athlete from potentially long term or catastrophic brain injuries.

  • A concussed athlete who continues to play is at an exponentially greater risk for long term or catastrophic brain injuries.
  • A concussed athlete who continues to play will prolong his or her recovery and create a more complicated recovery.

Immediate removal will not only protect the athlete from further brain injury but also protect themselves and their teammates from other sports injuries.

  • A concussed athlete who continue to play is more prone to lower extremity musculoskeletal injuries, such as a torn ACL. [1-5]
  • A concussion can affect the balance and coordination parts of the brain.
  • A concussed student athlete's athletic performance will decrease.
  • Baseball batting average decreased, missed catches and poor decision making due to concussion symptoms
  • A concussion can affect eye tracking, focusing and reaction time

What are the potential catastrophic brain injuries or long term effect of a concussion?

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  ??

  • Unconsciousness
  • Pupils dilated
  • Respiratory failure

Other long term effects of a concussion:

  • Longer recovery (protracted recovery). Most concussed student athletes will recover within 2-3 weeks. Hawai'i data has shown an average recovery of days.
  • Post-concussion syndrome is defined as concussion symptoms persisting well beyond the normal, expected recovery rates.
Additional resources
ACT 262 (pdf)

[1] Lynall, R.C., et al., Acute Lower Extremity Injury Rates Increase after Concussion in College Athletes. Med Sci Sports Exerc, 2015. 47(12): p. 2487-92.
[2] Herman, D.C., et al., Concussion May Increase the Risk of Subsequent Lower Extremity Musculoskeletal Injury in Collegiate Athletes. Sports Med, 2016.
[3] Gilbert, F.C., et al., Association Between Concussion and Lower Extremity Injuries in Collegiate Athletes. Sports Health, 2016. 8(6): p. 561-567.
[4] Dubose, D.F., et al., Lower Extremity Stiffness Changes after Concussion in Collegiate Football Players. Med Sci Sports Exerc, 2017. 49(1): p. 167-172.
[5] Brooks, M.A., et al., Concussion Increases Odds of Sustaining a Lower Extremity Musculoskeletal Injury After Return to Play Among Collegiate Athletes. Am J Sports Med, 2016. 44(3): p. 742-7.

Concussion Information

» What is a concussion?

» Signs and symptoms of a concussion

» Team Approach to Concussion Management

» Why is there a concussion law in Hawaii and what is second impact syndrome?