NJSBA Annual Meeting

My Kid's Not Playing Football: Legal Issues Surrounding

Concussions in Sports

Co-Sponsored by the Entertainment, Arts and Sports Law Section and

the Diversity Committee

Moderator/Speaker:

Kenneth E. Sharperson, Esq.

Weber Gallagher Simpson Stapleton Fires & Newby, LLC, Warren

Speakers:

Timothy D. Cedrone, Esq.

Apruzzese, McDermott, Mastro & Murphy, P.C., Liberty Corner

Mark Granger, Esq. Legal Consultant

Granger Legal Consulting

Hosea H. Harvey, J.D., Ph.D., Associate Professor of Law

Temple University School of Law

Cailyn Reilly, Esq.

Baker Botts, LLP, Washington, DC

The Head and the Heart: Today’s Perceptions of Head Injuries,

Helmet Products, and Related Litigation By Kevin R. Boully, Ph.D.

Concerns over the health risks related to head injuries in sports at all levels continue to grow.

Americans in all walks of life are more and more aware of the risks. Media coverage of highly public “concussion lawsuits” against the NFL, NCAA, NHL and more has been difficult to ignore. Medical experts have labeled sports concussion management a public health issue and the issue pervades discussion of sports and popular culture more broadly.1

Helmet makers, leagues, teams, and governing organizations are no longer on the sidelines. Lawsuits over the full range of head injuries are a reality, and both popular media and academic voices are sounding off.2 For the last five years we have been monitoring public perceptions and studying potential jurors’ reactions to key issues in head protection and litigation stemming from head injuries. Six findings from our 2016 National Juror Survey focused on issues of head protection in sports help to answer questions and inform strategy in head protection product lawsuits. (1) Perceptions of Head Injury Risk Are Becoming More Certain

Some of the damage remains clear and more people are becoming more certain in the belief that head injuries, like concussions, lead to significant long-term health impacts. In our most recent survey in late 2016, the overwhelming majority of the jury-eligible population (90%) reports the belief that a severe concussion is highly likely or somewhat likely to cause health problems in the future.

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The increase from 84% in 2012 is complimented by a substantial change in perceptions over the last five years. When asked to report their perceptions of the risk of concussion, fully 46% say their perception of the risk that concussion can cause significant future health problems is either much greater or somewhat greater than it was five years ago. It appears that more information leads to greater perceptions of significant future health problems.

Importantly, potential jurors continue to distinguish among the level of athletes perceived as the most vulnerable to future concussion-related health problems, finding younger athletes and professional athletes more vulnerable than college athletes. While there has been some annual fluctuation in reports, the trend is fairly clear: The youngest and most extreme (professional) athletes are most at risk.

Our research and experience continue to support the conclusion that the explanation for the

differing perceptions is that potential jurors view younger athletes as more vulnerable because they are still developing and suffering a concussion at a young age may halt or impact healthy development.

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Potential jurors tend to see professional athletes as more vulnerable due to violence that is unmatched at other levels. Regardless of the cause, trial counsel must address the fact that most potential jurors presume future harm related to severe concussions and view athletes as having differing levels of vulnerability to future harm.

Recommendation: Keep jurors in the here and now.

Jurors decide cases as much with their hearts, as with their minds. They are likely to view some plaintiffs (and plaintiff classes) as more vulnerable or simply more sympathetic than others – critical intelligence to inform risk in a given venue. More important for concussion defendants, however, is addressing two juror biases in concussion litigation: hindsight bias (that helmet makers and leagues should have known then the risks that we know now) and presumption of future harm. Combat these biases by focusing jurors’ attention on the here and now of every aspect of trial.

(1) Live and “Show” In the Relevant Time Period.

Use time-centric references and time-restricted visuals to focus jurors on the risk information that was known at the time relevant decisions were made, and encourage jurors to see the evidence as the defendant perceived it in the real-world. Take jurors back in time to when the key decisions were made. Whether it was “when there was not yet an iPhone” or when “the President was named George Bush” use cultural references to encourage jurors not to use information that was not available at the time of the events in question.

(2) Model the Use of Available Information In Voir Dire.

Model in voir dire how you must make due with only what you know in that moment about prospective jurors, about the judge, about the testimony, and that the future may turn out differently than we all expect. Ask jurors about their perceptions of that reality. Ask them about Monday Morning Quarterbacking and emphasize that the remedies include living in the present and relying only on what you know at a given moment.

(2) Product Makers Have a Responsibility to Protect Athletes

Perceived power to have prevented a negative outcome is a key filter for juror decision making. Potential jurors believe helmet makers can manufacture and sell helmets safe enough for astronauts and are likely to wonder why safer sports helmets were not developed sooner by defendant companies or required/recommended by a defendant team or league (again, hindsight bias). Plaintiffs pursue evidence that helmet makers and leagues knew of dangers and chose not to make or require safer products, thereby failing to protect players who had a right to believe they were being protected. At the same time, evidence that newer helmets are safer may also support a juror conclusion that helmet makers have responded to knowledge of risk by improving the technology and making players safer. Potential jurors generally view leagues and helmet makers as powerful shields for player safety, as evidenced by our annual survey results showing that leagues/organizations and helmet makers are perennially perceived as the most responsible for protecting athletes from head injuries.

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Some characteristics distinguish potential jurors’ perceptions of who should be held most responsible for athletes’ head injuries. Females (30%) are more likely than males (20%) to report helmet makers are most responsible. Males (31%) are statistically more likely than females (18%) to report the athlete as most responsible. Self-described Democrats (37%) are more likely than all other political affiliations (21%) to assign the greatest responsibility to the helmet maker. These and other factors such as potential juror ethnicity, as well as key attitudes are statistically significant predictors of jurors’ reports of the party most responsible for player head injuries.

It is also important to note that our most recent survey shows a meaningful shift in public perceptions on the key question of who has the greatest responsibility to make sure people are not injured by sports products that have a risk of injury. In 2016 the results show that nearly half (49%) say the manufacturer has the greatest responsibility, up from 32% just two years earlier.

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(3) Potential Jurors Maintain a Strong Baseline of Manufacturer Distrust

For over a decade we have observed significant distrust of corporations including product manufacturers. In 2016, fully 82% reported the belief that if a company could benefit by lying, it is probable that it would do so.

As helmets in particular become more commonly used and helmet products become more mainstream, the jury pool tends to view helmet makers as “bigger” and as comparable to the typical “corporation” that should be scrutinized, questioned, and doubted. Add to that baseline the reality that manufacturing and design often take place in China, and the reality that more than 90% of potential jurors believe product makers should do more testing than they currently perform, jurors find significant reasons to doubt manufacturers’ honesty and integrity, including helmet makers.

This general distrust, combined with the fact that nearly one in five (18%) of potential jurors

report an unfavorable opinion of sports product manufacturers, contributes to a meaningful proportion of the jury pool starting out a case with suspicions if not skepticism about the product maker’s honesty and motives. Consider the fact that nearly eight in ten (79%) say they trust very little or somewhat a sports product maker’s advertising claims.

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Recommendation: Level the playing field.

(1) Use Power and Choices to Your Advantage.

Demonstrate how your client used its power and choices fairly and effectively – always with consumer safety as a primary goal. For a helmet maker this means demonstrating how the manufacturer takes seriously its duty to protect its customers, is constantly advancing technology and developing products at the forefront of athlete protection while also communicating consistently (or at least responsibly) about its knowledge and the limits of any helmet’s ability to protect an athlete from all possible injuries.

(2) Surprise the Jury and Endorse Your Opponent.

Openly endorse the plaintiff(s) at trial. Make the strategic decision not to aggressively attack his, her or their credibility. Instead, make sure jurors see them as active consumers of products who have options and choices available to them (including the choice of whether or not to engage in the risky recreational or sports activity). The more jurors perceive the Plaintiff as having power and ability to know much more than the average juror about the health risks of their sport, the more they understand the risks are inherent and the power is distributed among the athletes as much as the helmet companies (and others involved in the chain of athlete safety).

(4) High Personal Responsibility Still Predominates

There is also some good news for product makers that applies to sports product makers and helmet makers in particular. Personal responsibility remains one of the strongest filters through which jurors perceive Plaintiff’s claims. In our latest research, 70% say that when it comes to responsibility for safe use of sports products, people need to take more responsibility for their actions, while just 30% say companies need to take more responsibility for their products.

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When asked to consider the specific question of how often consumers follow the recommended safety precautions when using exercise equipment, more than half (51%) believe consumers often or almost always follow the recommended precautions and are using the equipment appropriately.

(5) Most Potential Jurors See Themselves as Plaintiffs More than half (53%) of surveyed potential jurors reported they would probably or definitely pursue a lawsuit against a product maker if they suffered a significant bodily injury while using a sporting good or recreational product. Juror attitudes and experiences (and to some extent, demographics) are statistically significant predictors of willingness to pursue a lawsuit. For instance, the perception that there are too few lawsuits filed against large corporations has been predictive of a greater likelihood to report willingness to sue a helmet maker for a head injury.

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Perceptions of sporting good manufacturers’ product testing is a crucial aspect of jury decision making in all sports product cases, and is a relevant predictor of potential jurors’ attitudes. Specifically, 62% of potential jurors who believe sports product companies often or almost always place products on the market that are not adequately tested say they would probably or definitely pursue a lawsuit against a helmet maker. Just 48% of those who believe sports products are rarely or almost never placed on the market without adequate testing say they would do the same. Other attitudes, including perceptions of environmental harm caused by corporations and frequency with which lawsuits against corporations have merit, are also related to increased willingness to pursue a lawsuit.

Recommendation: Develop a high-risk juror profile.

A high-risk juror profile in an injury lawsuit against a helmet maker should focus on a number of critical juror attitudes. The following are among a set of high-risk juror attitudes:

• Believes helmet makers are more responsible than athletes for ensuring the safe use of a helmet product

• Believes a helmet should protect an athlete from severe head injury • Believes there are too few lawsuits against large corporations • Believes most sports products are not adequately tested before being

placed on the market • Believes jury verdicts are the only way to force change in the sports

industry • Believes the government should police corporations much more • Believes corporations should be held to much greater responsibility

than individuals

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(6) Shifting Perceptions of Government Regulators Can Play a Key Role

A strong majority of potential jurors (82%) report favorable perceptions of sports product manufacturers and 29% say that in the last five years their perceptions of sports product manufacturers have become much better or somewhat better. Importantly for helmet makers, the improvement in opinions is even greater, with 39% saying their opinions of helmet makers have become much better or somewhat better in the last five years.

Overall, only consumer product makers enjoy a higher proportion of favorable ratings

than sports product makers, who compare favorably in the list of options provided in our most recent survey. At the same time, perceptions of government regulators have been on the decline for quite some time, with our 2016 results showing a majority (52%) having unfavorable opinions of government agencies.1

1 Early 2017 survey results show 56% report favorable opinions of government agencies. This could be an artifact of the change in the presidential administration from President Obama to President Trump and is something we will continue to monitor going forward.

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Our experience in the last few decades has been a relatively steady decline of perceptions of most government agencies, increases in perceived “partnerships” between corporate interests and their regulating bodies, and more and more skepticism of the quality and sufficiency of rules and regulations intended to provide benchmarks for corporate conduct throughout industry. For instance, the fact that a helmet maker only meets Consumer Product Safety Commission (CPSC) requirements for a manufacturer’s internal product testing is generally not enough to persuade a jury the testing was appropriate, sufficient and responsible. This is one of the many ways we have observed the manifestation of shifting perceptions of regulators and regulations impacting juror perceptions of sports product liability.

Recommendation: Test your venue early.

Every venue is different and trial risk in each venue depends on a variety of case-specific factors. The attitudes, experiences, and juror characteristics associated with leanings in concussion disputes provide a basic idea of possible risk in a given venue. Early focus groups and/or survey research in a specific venue will contextualize these findings and put a finer point on your client’s risk.

More importantly, the lessons learned in early research will allow you to make informed decisions in discovery and garner the testimony and evidence proven to be more persuasive to jurors in your case.

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To have a more detailed conversation about how these findings may affect your litigation strategy, please contact Kevin Boully at krboully@persuasionstrategies.com or 303-295-8476.

In November of 2016 Persuasion Strategies conducted a national research study of 462 jury-eligible participants that focused on four areas of jury-eligible participants’ perceptions: 1) sports product safety and litigation; 2) concussion injuries and concussion-related litigation; 3) athletic product advertising; and 4) corporate conduct more generally. This survey furthers findings from numerous questions Persuasion Strategies has asked on a national scale in past years, allowing us to evaluate changes in perception over time, if any.

References: 1 See for instance the Testimony of Jeffrey Kutcher, M.D. on “Legal Issues Relating to Football Head Injuries, Part II,” before the United States House of Representatives Committee on the Judiciary. January 4, 2010. 2 See for instance, Keating, P. (2011). “Coming to a Head.” ESPN Magazine. Retrieved March 28, 2012 from http://sports.espn.go.com/espn/news/story?id=5970086

Model Policy and Guidance for Prevention and Treatment of Sports-Related Concussions and Head Injuries

Introduction This document is designed to provide guidance to local district boards of education in the development, establishment, and implementation of policies, procedures and programs for the prevention, treatment, and education of Sports- Related Concussions and Head Injuries.

Part I Background

Legislation (P.L. 2010, Chapter 94) (N.J.S.A. 18A:40-41.3) enacted on December 7th, 2010 requires each school district, charter , and non-public school that participates in interscholastic athletics to adopt by September 1, 2011, a policy concerning the prevention and treatment of sports- related concussions and other head injuries among student- athletes. The Center for Disease Control estimates that 300,000 concussions are sustained during sports- related activity in the United States. A concussion is a traumatic brain injury (TBI) caused by a direct or indirect blow to the head or body. In order to ensure the safety of student-athletes, it is imperative that athletes, coaches, and parents/guardians are educated about the nature and treatment of sports- related concussions and head injuries. Allowing a student-athlete to return to play before recovering from a concussion increases the chance of a more serious brain injury that can result in severe disability and/or death. To assist each district board of education, board of trustees, and non-public school in developing its sports-related concussion and head injuries policy, the legislation required the Commissioner of Education to issue a model policy applicable to grades kindergarten through twelve (K-12), by March 31, 2011. This document includes appropriate references to statutes, regulations and emergent information on sports-related concussions and head injuries.

Part II Guidance For Local Policy Development

Policy Context The New Jersey Department of Education (NJDOE) recognizes that the decisions made on the policy governing the care of student-athletes who have sustained sports-related concussions and head injuries is dependent on the individual characteristics in each school district, charter, and non-public school. Each district board of education, charter, and non-public school policy, however, must comply with the

minimum requirements stated in N.J.S.A. 18A: 40-41.4 in regards to the care and treatment of a student-athlete who is suspected of sustaining a sports-related concussion or head injury. Local Policy Development The following descriptions of applicable regulations make it clear that the content and format of local policies and procedures must be developed locally: • Each district board of education, board of trustees, and non-public school will adopt an Interscholastic

Head Injury Training program to be completed by the School/Team Physician, Licensed Athletic Trainer, Coaches, School Nurses, and other appropriate district personnel pursuant to N.J.S.A. 18A:40-41.2

• Each district board of education, board of trustees, and non-public school must develop its written policy concerning the prevention and treatment of sports-related concussions and head injuries in accordance with N.J.S.A. 18 A:40-41.3.

• Each district board of education, board of trustees, and non-public school must review their sports-related concussion and head injury policy annually , and update as necessary, to ensure that it reflects the most current information available on the prevention, risk, and treatment of sports related concussions and head injuries pursuant to N.J.S.A. 18A:40-41.3.

Requirements for Policy Contents Each district board of education, board of trustees, and non-public school has local control over the content of the Sports-Related Concussion and Head Injury Policy, except that the policy must contain, at a minimum, the following components: • 18A:40-41.4- Removal of student-athlete from competition, practice; return.

A student who participates in interscholastic athletics and who sustains or is suspected of sustaining a concussion or other head injury shall be immediately removed from practice or competition. The student-athlete may not return to play until he/she has obtained medical clearance in compliance with local school district return-to-play policy.

• All Coaches, School Nurses, School/ Team Physicians and Licensed Athletic Trainers must complete an Interscholastic Head Injury Training Program.

• The Athletic Head Injury training program must include, but not be limited to: 1. The recognition of the symptoms of head and neck injuries, concussions, risk of secondary

injury, including the risk of second impact syndrome; and 2. Description of the appropriate criteria to delay the return to sports competition or practice of a

student –athlete who has sustained a concussion or other head injury. • An Athletic Head Injury Training program such as the National Federation of State High Schools

Association online “Concussion in Sports” training program or a comparable program that meets mandated criteria shall be completed by the above named staff or others named by local district/school policy. Additional head injury training programs that meet the mandated criteria may be completed by professionals of different levels of medical knowledge and training. Guidance for these additional training programs will be provided to each school district, charter and non-public school by the NJDOE.

• Distribution of NJ Department of Education Concussion and Head Injury fact sheet to every student-athlete who participates in interscholastic sports. Each school district, charter or non public school,

that participates in interscholastic sports shall obtain a signed acknowledgement of the receipt of the fact sheet by the student-athlete’s parent/ guardian and keep on file for future reference.

Model Concussion Protocol for the Prevention and Treatment of Sports-Related Concussions and Head Injuries

Prevention 1. Pre-season baseline testing. 2. Review of educational information for student-athletes on prevention of concussions. 3. Reinforcement of the importance of early identification and treatment of concussions to

improve recovery. • Student-athletes who are exhibiting the signs or symptoms of a sports-related concussion or other

head injuries during practice or competition shall be immediately removed from play and may not return to play that day.

Possible Signs of Concussion: (Could be observed by Coaches, Licensed Athletic Trainer, School/Team Physician, School Nurse)

1. Appears dazed, stunned, or disoriented. 2. Forgets plays, or demonstrates short term memory difficulty. 3. Exhibits difficulties with balance or coordination. 4. Answers questions slowly or inaccurately. 5. Loses consciousness.

Possible Symptoms of Concussion (Reported by the student athlete to Coaches, Licensed Athletic Trainer, School/ Team Physician, School Nurse, Parent/ Guardian)

1. Headache 2. Nausea/Vomiting 3. Balance problems or dizziness. 4. Double vision or changes in vision. 5. Sensitivity to light or sound/noise. 6. Feeling sluggish or foggy. 7. Difficulty with concentration and short term memory. 8. Sleep disturbance. 9. Irritability

• Student-Athletes must be evaluated by a physician or licensed health care provider trained in the evaluation and management of concussion to determine the presence or absence of a sports-related concussion or head injuries.

• To return to practice and competition the student-athlete must follow the protocol: 1. Immediate removal from competition or practice. 911 should be called if there is a

deterioration of symptoms, loss of consciousness, or direct neck pain associated with the injury.

2. When available the student-athlete should be evaluated by the school’s licensed healthcare provider who is trained in the evaluation and management of concussions.

3. School personnel (Athletic Director/Building Administrator, Licensed Athletic Trainer, School Nurse, Coach, etc.) should make contact with the student-athlete’s parent/guardian and inform him/her of the suspected sports-related concussion or head injury.

4. School personnel (Athletic Director/ Building Administrator, Licensed Athletic Trainer, School Nurse, Coach, etc.) shall provide the student-athlete with district board of education approved suggestions for management/ medical checklist to provide their parent/guardian and physician or other licensed healthcare professional trained in the evaluation and management of sports related concussions and other head injuries (See attachment sections at end of model policy for examples CDC, NCAA, etc.)

5. The student-athlete must receive written clearance from a physician, trained in the evaluation and management of concussions that states the student-athlete is asymptomatic at rest and may begin the local districts’ graduated return-to-play protocol. Medical clearance that is inconsistent with district, charter, and non-public school policy may not be accepted and such matters will be referred to the school/team physician.

Graduated Return to Competition and Practice Protocol • Complete physical, cognitive, emotional, and social rest is advised while the student-athlete is

experiencing symptoms and signs of a sports-related concussion or other head injury. (Minimize mental exertion, limiting overstimulation, multi-tasking etc.)

• After written medical clearance is given by a physician trained in the evaluation and management of concussions stating that the student-athlete is asymptomatic at rest, the student-athlete may begin a graduated individualized return-to-play protocol supervised by a licensed athletic trainer, school/team physician or in cases where the afore mentioned are not available a physician or licensed health care provider trained in the evaluation and management of sports-related concussions. The following steps should be followed: 1. Completion of a full day of normal cognitive activities (school day, studying for tests,

watching practice, interacting with peers) without re-emergence of any signs or symptoms. If no return of symptoms, next day advance to:

2. Light aerobic exercise, which includes walking, swimming, or stationary cycling, keeping the intensity < 70% maximum percentage heart rate: no resistance training. The objective of this step is increased heart rate. If no return of symptoms, next day advance to:

3. Sport-specific exercise including skating, and/or running; no head impact activities. The objective of this step is to add movement and continue to increase heart rate. If no return of symptoms, next day advance to:

4. Non-contact training drills (e.g., passing drills). The student-athlete may initiate progressive resistance training. If no return of symptoms, next day advance to:

5. Following medical clearance (consultation between school health care personnel, i.e., Licensed Athletic Trainer, School/Team Physician, School Nurse and student-athlete’s physician), participation in normal training activities. The objective of this step is to restore confidence and to assess functional skills by the coaching staff. If no return of symptoms, next day advance to:

6. Return to play involving normal exertion or game activity. • In the absence of daily testing by knowledgeable school district staff (i.e. Licensed Athletic

Trainer, School/Team Physician) to clear a student-athlete to begin the graduated return-to-play

protocol a student –athlete should observe a 7 day rest/recovery period before commencing the protocol. Younger students (K-8) should observe the 7 day rest/recovery period (after they are symptom free at rest) prior to initiating the graduated-return-to play protocol. A physician trained in the evaluation and management of concussion as well as the parents/guardians of the student-athlete shall monitor the student-athlete in the absence of knowledgeable school district staff (i.e., Athletic Trainer, School/Team Physician). School Nurses may serve as an advocate for student-athletes in communicating signs and symptoms to physicians and parents/guardians.

• Utilization of available tools such as symptom checklists, baseline and balance testing are suggested.

• If the student athlete exhibits a re-emergence of any concussion signs or symptoms once they return to physical activity, he/she will be removed from further exertional activities and returned to his/her school/team physician or primary care physician.

• If concussion symptoms reoccur during the graduated return-to-play protocol, the student-athlete will return to the previous level of activity that caused no symptoms.

Temporary Accommodations for Student-Athletes with Sports-Related Head Injuries • Rest is the best “medicine” for healing concussions or other head injuries. The concussed brain

is affected in many functional aspects as a result of the injury. Memory, attention span, concentration and speed of processing significantly impacts learning. Further, exposing the concussed student-athlete to the stimulating school environment may delay the resolution of symptoms needed for recovery.

• Accordingly, consideration of the cognitive effects in returning to the classroom is also an important part of the treatment of sports-related concussions and head injuries.

• Mental exertion increases the symptoms from concussions and affects recovery. To recover, cognitive rest is just as important as physical rest. Reading, studying, computer usage, testing, texting – even watching movies if a student is sensitive to light/sound – can slow a student's recovery. In accordance with the Centers for Disease Control's toolkit on managing concussions boards of education may look to address the student’s cognitive needs in the following ways.

• Students who return to school after a concussion may need to: 1. Take rest breaks as needed. 2. Spend fewer hours at school. 3. Be given more time to take tests or complete assignments. (All courses should be

considered) 4. Receive help with schoolwork. 5. Reduce time spent on the computer, reading, and writing. 6. Be granted early dismissal to avoid crowded hallways.

Part III

Use of the Model Policy and Guidance

This document is presented as a summary guide and model. District boards of education, boards of trustees, and non-public schools may add additional provisions or protocols to address local issues and priorities, and may use formats that are consistent with the board of education’s approved policies and procedures.

Part IV

Implementation of the Interscholastic Sports-Related Concussions and Head Injuries Policy Statutory and Regulatory Provisions: N.J.S.A. 40-41.3 Information regarding the Interscholastic Head Injury Safety training program and policy for the prevention and treatment of sports-related concussions and head injuries which shall be completed by the school/team physician, coaches, athletic trainer, school nurse, and any other school employee the local district, charter, and non-public school deems necessary. The school district, charter, and non-public school are required to monitor the above named school district employees in the completion of an Interscholastic Head Injury Training program such as the National Federation of State High Schools Association’s online, “Concussion in Sports” or a comparable program which meets the mandated criteria and includes but is not limited to: 1. The recognition of the symptoms of head and neck injuries, concussions, and injuries related to

second-impact syndrome. 2. Includes the appropriate criteria to delay the return to sports practice or competition of a student-

athlete who has sustained a concussion or other head injury. *Additional head injury training programs that meet the mandated criteria may be completed by professionals of different levels of medical knowledge and training. Guidance for these additional training programs will be provided to each school district, charter, and nonpublic school by NJDOE.

The school district, charter, or nonpublic school that participates in an interscholastic sports program shall distribute the educational fact sheet annually to the parents or guardians of student-athletes and shall obtain a signed acknowledgement of the receipt of the fact sheet by the student-athlete and his parent or guardian. Each school district, charter, and non-public school shall develop a written policy concerning the prevention and treatment of sports-related concussions and other head injuries among student-athletes. The policy shall include, but need not be limited to, the procedure followed when it is suspected that student-athlete has sustained a concussion or other head injury. Each school district shall implement the policy by the 2011-2012 school year. Each school whose students participate in an interscholastic sports program and are suspected of sustaining a concussion or other head injury in practice or competition shall be immediately removed from the sports competition or practice. Student-athletes who are removed from competition or practice shall not participate in further sports activity until they are evaluated by a physician or other licensed healthcare provider trained in the evaluation and management of concussions, and receive written

clearance from a physician trained in the evaluation and management of concussions to return to completion or practice.

Part V

Resources on Interscholastic Sports Related Concussions and Head Injuries

Internet Resources Centers for Disease Control and Prevention – Concussion Toolkit http://www.cdc.gov/concussion/HeadsUp/physicians_tool_kit.html http://www.cdc.gov/concussion/headsup/pdf/ACE-a.pdf http://www.cdc.gov/concussion/headsup/pdf/ACE_care_plan_school_version_a.pdf http://www.cdc.gov/concussion/headsup/pdf/Concussion_in_Sports_palm_card-a.pdf National Federation of State High Schools Association- Online “Concussion in Sports” training program. www.nfhs.org Brain Injury Association of New Jersey www.BIANJ.org www.sportsconcussion.com Athletic Trainers Society of New Jersey www.atsnj.org National Collegiate Athletic Association www.NCAA.org/health-safety New Jersey Interscholastic Athletic Association www.njsiaa.org Articles “Consensus Statement on Concussion in Sport: 3rd International Conference on Concussion in Sport held in Zurich, November 2008”. Clinical Journal of Sports Medicine, Volume 19, May 2009, pp.185-200 Clinical Report: Sport-related Concussion in Children and Adolescents” Halstead ME, Walter, KD and the Council on Sports Medicine and Fitness Pediatrics Volume 126, September 2010, pp.597-615.