In 2010, the Centers for Disease Control and Prevention estimates 130,000-high-school-aged athletes suffer from concussions or concussion-like symptoms every year in the United States. Six years prior, the CDCP reported that while statistically 1-in-10 sports related injuries are head or concussion related, it thought the number should be much higher – citing lack of awareness and reporting.

In its own 2004 study, the Clinical Journal of Sports Medicine reported that only 47-percent - less than half - of all high school concussions were being reported. The study noted the athletes and coaches lack of concussion knowledge and loss of playing time as contributing to low reporting numbers.

By 2011, the CDCP reported that 3.8 million concussion or concussion-like injuries occurred in the US every year – quite the jump from the previous reporting year.

The minimal knowledge on the effects of concussions and subsequent misreporting of symptoms can very possibly be traced to the lack of full-time athletic trainers available to a staggering number of Texas high schools.

Dallasnews.com reported that while the majority of 5A and 4A schools (6A and 5A after the 2013 realignments) had at least one athletic trainer present at all times, the schools 3A and below didn’t during the 2010-11 school year. Some of the smaller schools often had a certified athletic trainer present on the sidelines during games, but rarely during practices, according to the DMN article. Over half, 53 percent, of all UIL sanctioned schools did not employ a full-time athletic trainer, and 33 percent of those schools did not even have weekly access to one, the same report said.

Also in 2010, Tamara C. Valovich McLeod – a respected expert in concussion field – said that youths often take more time than adults to recover from head injuries. She also stated that even minor concussions could cause permanent brain damage, especially when repeated concussions begin adding up. If the concussion is not treated correctly the first time, the recovery time will be longer for the next concussion and the likelihood of a repeat head injury increases – especially in youth athletes – McLeod said.

The Texas UIL took its first steps to a standardized concussion protocol in 2007 following the death of a high school athlete Will Benson. The State Legislature passed “Will’s Bill,” and became the first state to pass a law that required every employee of a UIL sanctioned school to annually attend a head injury safety and treatment training program.

The bill amended a portion of the Texas Education Code. The key provisions are located under Sections 33.202 and 33.205 of Subchapter F of the TEC. Section 33.202 reads as follows:

“Requires a coach, trainer, or sponsor for extracurricular athletic activity, to complete safety training. Recognizing symptoms of potentially catastrophic injuries, including head and neck injuries, concussions and injuries related to second impact syndrome must be included in the safety-training program. A school district must also provide training to students to recognize the symptoms of concussions, head and neck injuries and second impact syndrome. A safety drill incorporating the training must be performed at least once a school year.”

Until this amendment was passed, schools were not required to have anyone with concussion or head injury training present at practices, games or medical treatment sessions. UIL schools were also not required by law to inform athletes on the potential dangers of concussions or head injuries.

The next section addressed the return-to-play protocol that an athlete was required to follow after receiving a concussion or head injury – note the use of the word “consciousness.” Section 33.205(b) reads:

“If a student participating in an extracurricular athletic activity, including a practice or competition becomes unconscious during the activity, the student may not: (1) return to the practice or competition during which the student became unconscious; (2) participate in any extracurricular athletic activity until the student receives written authorization for such participation from a physician.”

A player does not have to lose “consciousness” in order to receive a significant brain injury or a concussion, in fact, McLeod used the term “having your bell rung” as a possible sign of being concussed.

Benson, the bill’s namesake, was a 17-year-old quarterback at St. Stephens Episcopal in Austin and died after receiving a head injury in September of 2002, multiple reports said. Benson returned to the field two weeks after becoming concussed, suffered another helmet-to-helmet blow, collapsed, slipped into a coma, and passed away six days later, according to the reports.

Lawyersandsettlements.com reported that the Benson’s attempt to sue the school in 2008 for “negligence that led to their son’s cerebral brain hemorrhage that ultimately resulted in his death.” The court found the school ‘not guilty,’ citing lack of laws concerning concussion protocol at the time of the incident, the site stated.

KVUE News in Austin later reported, that the school had reached a $1 million settlement with the Benson family to “resolve any possible wrongful death allegations.”

The UIL took a major step forward in its concussion protocol in 2011. In Feb. 2010, state Senator Bob Deuell (R) from Greenville filed legislation to address concussions in high school sports. Deuell’s legislation aimed to lower the number of multiple concussions an athlete might receive – and in turn – decrease the chances for long-term brain or neurological damage. The highlights of Sen. Deuell’s bill were:

• Any student-athlete who shows concussion-like symptoms must be removed from the contest immediately. The athlete is then subjected to multiple tests to be conducted by a physician, and at least one member of the school’s concussion management team. If both the physician and team member pass the athlete, then he/she may reenter the contest.

• Schools – public and private – must submit a list of all concussions tested for, and received to their school district’s governing body yearly.

• The “concussion management team” will consist of one physician, at least one athletic trainer, and at least one advanced nurse practitioner or physician’s assistant. All of the team members – including health care professionals, athletic trainers and coaches – will be required to complete a state-approved concussion training course every two years.

• If an athlete is found to have a concussion, the protocol for his/her return to play would require a plan being made by the concussion management team and the player’s parents.

NFL commissioner Roger Goodell backed Sen. Deuell’s legislation in a letter to former Gov. Rick Perry. “We believe that sports and political leaders can help raise awareness of these dangerous injuries and better ensure that they are treated in the proper and most effective way. This legislation will better protect high school athletes by mandating stricter regulations regarding concussions,” Goodell said in his letter dated May 21, 2010.

The UIL’s Legislative Council approved the rule change in Oct. 2010 and Texas Commissioner of Education Robert Scott signed TX HB2038 on March 25, 2011.

The new concussion protocol began on Aug. 1, 2011, and restricts the athlete from returning to the field until receiving an approval from the concussion protocol team, and obtaining a signed letter of clearance from a certified physician – none of which can be done prior to sitting-out for at least 24 hours.

Source: Smith, Travis M. “Concussions: A Headache of a Problem.” Brownwood Bulletin. N.p., 15 June 2015. Web. 15 June 2015.