In 2009, the Washington State Legislature passed the Zackery Lystedt law, named after a boy whose life was dramatically altered by a concussion sustained in a football game. The Lystedt law requires schools and the Washington Interscholastic Activities Association (WIAA) to develop information and forms to educate coaches, parents, and young athletes about the risks of concussion and head injury, and to develop guidelines for the management of concussion and head injury. Schools must distribute information to parents and young athletes at least annually, but there is no similar requirement for non-school athletic programs, and many participants in non-school athletic programs are not adequately trained and do not have adequate policies in place to manage concussion and head injury.
The Lystedt law requires coaches and others involved in youth sports (both school and non-school) to remove young athletes from play immediately if they are suspected of having a concussion of head injury. Symptoms and signs of concussion and head injury include: headaches, pressure in the head, nausea or vomiting, balance problems, feeling sluggish or fatigued, or concentration or memory problems. A complete list of signs and symptoms, along with other information and resources, are available from the WIAA website (www.wiaa.com).
Once a young athlete has been removed from play, they may not be returned to play until they have been evaluated by a licensed health care provider trained in the evaluation and management of concussion and head injury and receives written clearance. Not all health care providers have the training or experience to recognize and properly evaluate and manage concussion and head injury.
The Washington Supreme Court recently held that schools and coaches who fail to comply with the requirements of the Lystedt law are subject to liability for injuries suffered by young athletes, in a case involving a young man who died after receiving a second concussion in in a high school football game played the week after he received his first concussion. The case illustrates the danger posed by continuing to play with a concussion and then receiving another concussion (called second impact syndrome).
While the Lystedt law refers to "generally accepted return to play standards," the Supreme Court held that the law did not impose liability on schools and coaches for failing to follow those standards (although they may still be liable on grounds of negligence for failing to do so). The return to play standards require a gradual return to play to ensure that a young athlete has fully recovered from a concussion and avoid second impact syndrome.
The first step for gradual return to play following concussion consists of complete physical and cognitive rest to allow for recovery; the second step consists of light aerobic exercise to increase heart rate; the third step consists of sport-specific exercise to add movement; the fourth step consists of non-contact training drills to provide exercise, coordination and cognitive load; the fifth step involves full contact practice; and the final sixth step is a return to normal play. Generally, each step should take a minimum of 24 hours so that an athlete would take at least six days to complete the gradual return-to-play process. It is important to emphasize that this is a minimum. Gradual return to play is important for all athletes, including adults, but it is especially important for children and adolescents because they have different physiological response and longer recovery after concussion, as well as specific risks related to head impact during childhood and adolescence.