Writers of Pro Football Prospectus 2008

26 Jul 2010

NFHS Steps Backward on Concussions

The National Federation of High School Associations handles officiating in a very similar fashion to the NFL: Each year, certain rules are reexamined and modified, and points of emphasis are issued. These changes and emphases are sent out to high school officials, coaches and directors in various publications. Considering last year's firestorm over concussions, no one was surprised when the NFHS decided to put "concussion recognition and management" on the top of the points of emphasis. Beyond that, however, a rule change was in order.

A timeout occurs when an apparently unconscious player is determined by the game officials. The player may not return to play in the game without written authorization from a physician (M.D./D.O.). This time-out, if not charged, is an official's time-out.

There were a lot of problems with the old rule's language; "apparently unconscious" gives the officials authority to remove concussed players from the game, but the vagueness of "unconscious" left officials out on a limb whenever a player was conscious and partially responsive. The new rule allows officials to remove players who show signs, symptoms or behaviors consistent with a concussion. This may seem like a small change, but the NFHS has a medical committee which publishes very specific guidelines regarding concussions. Everyone is finally on the same page.

The NFHS sadly took a step backward in the "enforcement" section of the rule. Where before a player could only reenter play with written authorization, a player may now reenter play after being "cleared" by an appropriate health-care professional, as defined by the host state. "Cleared" is left undefined, but the rules committee made it clear that it no longer means written authorization. This change seems pretty benign, until you read the examples which accompany the new rule, which officials rely upon for interpretation:

With 4:37 to play in the first quarter, A1 exhibited signs of a possible concussion and was sent out of the game by the officials. When the second quarter begins, A1 is sent back into the game.
Ruling: Legal. If A1 returns, the officials are to assume an appropriate health-care professional approved, as re-entry is a coach's decision. However, if A1 again shows signs consistent with a concussion, he should be sent off again.

There is a world of difference between written authorization from a licensed professional and the assumption that a player has been "cleared." A written authorization has the doctor's name, the player's name, and enough important facts to create a clear paper trail, both to protect the doctor and to allow the officials or parents to complain to the state association should a player be sent back into the game before it is safe. Of course, moving re-entry solely into the realm of "coach's decision" really turns medical clearance into kabuki theater:

A1 sustains a hard but legal hit and is slow to get to his feet. When he does rise, he holds his head and has trouble keeping his balance. The officials send A1 off the field. There is no appropriate health-care professional on site. A1 is sent back into the game after sitting out one down.
Ruling: Responsibility for A1's return falls on the head coach. The officials are not required to determine if an appropriate health-care professional has examined and cleared A1.

So, officials are to assume players have been checked, that they have been cleared, and even if there is no one there to clear the player, stick their heads in the sand. While making it easier for officials to remove a player from play, the NFHS at the same time has made it far harder to actually keep injured players out of the game. Faced with an unscrupulous coach, in fact, the officials have no recourse save repeatedly removing the player and making him sit out one play at a time, which is almost certain to end badly for the official -- reentry is a coach's decision, remember?

While the rest of the football community is taking a hard look at concussion management, high school players -- the most vulnerable players with the least control over their fate -- have been stripped of what little protection they had. Reentry can have serious consequences for a concussed player, including paralysis and death. That the NFHS has essentially put concussion enforcement on the coach's shoulders just shows how far we have to go on this deadly serious issue.

I called the NFHS to get an official explanation or statement about the new rule, but they did not return my call.

Posted by: Will Carroll on 26 Jul 2010

10 comments, Last at 29 Jul 2010, 2:18pm by Just me


by Simon (not verified) :: Mon, 07/26/2010 - 2:17pm

Wow. Is it just me, or does it seem like they're intentionally giving themselves an out if something bad happens with a player who has re-entered a game by putting the blame on the coach?

by Marty (not verified) :: Mon, 07/26/2010 - 3:48pm

I think this mostly puts the onus of safety on the head coach - and not the officials. it's a liability change, and while it removes another step in the prevention of a serious head injury (bad), it places the health of the player(s) squarely on the head coach (which is logical, if not a bit ominous for all coaches)

by Joseph :: Mon, 07/26/2010 - 4:05pm

With as popular as HS football is in at least the southern states, how hard would it be to have a "licensed health-care professional" on site at each game. I mean, at a reasonable percentage of games, that could be some kid's PARENT. NFHS, bad move. I understand not making the officials responsible--but just leave the written authorization rule in place. If I were a HS coach, I am going to care less about winning and more about parent X suing me for everything I have if their kid has serious health problems. (Maybe this isn't such a bad thing after all.)
Liability insurance employees, contact your local HS football coach immediately!! :)

by Will Carroll :: Mon, 07/26/2010 - 8:02pm

A significant number of football games won't have even a visiting Athletic Trainer, let alone a doctor, at games. This says nothing about the fact that almost no HS teams will have a Trainer at practices or even available. The coaches are going to be protected by waivers and the community in most cases.

by Mello :: Mon, 07/26/2010 - 5:08pm

Good change. The coaches are responsible for the players, not the refs. Unscrupulous coaches will be taking a significant risk for the kid, themselves, and their school if he doesn't have the player properly cleared. I'd be more worried about unscrupulous doctors. But then I've never been convinced major changes are required for concussions.

by Independent George :: Mon, 07/26/2010 - 5:26pm

Upon reflection, this isn't quite as terrible as I first believed. Players could conceivably be placed in greater danger under the old rules - that is, if they are more likely to stay out of a game due to the stringent written documentation requirements, officials are likely to be less inclined to yank a player for minor symptoms. If the ref knows that the onus is now shifted to the coaching staff, he is less likely to be pressured to keep the players in the game.

The key point is whether the players are truly examined on the sidelines by a medical professional, or if teams just pay lip service to it. Here it actually makes sense to distribute that closest to the individual teams - that is, since coaches are much closer to the players & parents than a centralized bureaucracy, they seem less capable of CYA through bureaucratic shenanigans. The paper trail seems most useful for auditing, but not especially effective for in-game decisions. How much do you want to bet that team doctors had pre-written certifications ready at game time, that needed only to be signed & dated to order? Police officers in Illinois have been known to keep pro-forma traffic tickets & arrest reports that are merely signed & dated at the scene (and sometimes weeks later).

by Jimmy Oz (not verified) :: Mon, 07/26/2010 - 7:55pm

I hope coaches/trainers are made aware of symptoms in players suspected of suffering concussions because i think you touch on a good point.

Without knowing how the rule was applied previously, we can't really say whether this is a good move or a backward step. If the rule change didn't improve the treatment of concussed players, then it needs to be changed again. Obviously the powers that be, hopefully in consultation with officials and coaches, didn't think the rule improved treatment as it stood.

by HLinNC (not verified) :: Mon, 07/26/2010 - 10:43pm

Will, your premise is incorrect. The prior rule only required a written note from a doctor for a player deemed to be unconscious. Studies show that many times there is no loss of consciousness. We had no legitimate way to know if the note authorizing return was written by a brain surgeon or a vet.

Under this rule the onus falls not only on the coach but the school administration. Each state's governing body is being left the discretion to determine what an "appropriate health care professional" If a coach truly wishes to sacrifice his career and his life savings on an ill advised idea to return a concussed player to the field, then no rule will protect his kids.

Here are some officiating message board topics you can peruse about the subject.






by Mike Kurtz :: Tue, 07/27/2010 - 12:08am

Those links you posted are full of the same concerns raised by this article and by Will in his comment above; high school sports have waivers coming out of their ears, and concussions are poorly understood by even those in the know, much less random people in the community.

The problem with the "it's the coach's ass" argument was that the entire formulation of the old rule was to protect players from coaches, requiring some kind of medical process to make sure that the player can safely re-enter. Saying the responsibility is now on coaches to make sure that players are only returned when medically safe is like saying the onus is on the wolf to make sure that nothing eats the hens. Technically true, but in the end meaningless.

I think that we'll see, again as discussed in the links you provided, state associations adopting as strict interpretations of the rule as possible, including defining cleared back to written authorization.

edit: Incidentally, I think there's far too much discussion of who is responsible for what under the rule. In the end, the only sane metric is if it makes the players themselves safer.

by Just me (not verified) :: Thu, 07/29/2010 - 2:18pm

And exactly how did any official actually know that note was signed by someone who had even looked at the kid or had any sort of expertise to make that judgement? That note could have been filled out & signed by Joe the janitor for all we know. That note was not a magic shield of protection for the player. The unscrupulous coach could easily find a way around the "note rule" just as easy as ignoring the requirement the player be evaluated.
What the current rule does is require the school to have some sort of health care professional accessable. And the evaluation has to be made on any player exhibiting signs of any concussive symptom, not just after he's been knocked out. And it's to be made by the people who know the player and have the time to make an evaluation. This is a step forward.