Concussion: Why Nurses Need to Understand This Hidden Injury

Ann Worley


Pediatr Nurs. 2019;45(5):235-243. 

In This Article

Public Legislation: Return to Play Guidelines

Since 2014, all 50 U.S. states have some type of return to play (RTP) laws in place requiring school students to be removed from play after sustaining a head injury and to remain out of play until being evaluated by a physician or trained provider other than a coach (McCrory et al., 2017). Known as Lystedt laws (the first being named after Zackary Lystedt in 2009), these state laws basically require athletes, coaches, and parents to sign a concussion waiver to comply with the law, and that these individuals, as well as all school personnel, receive concussion awareness education (Yang, Comstock, Yi, Harvey, & Xun, 2017). However, the scope and consistency of these laws vary. The laws in some states, for example, only regulate public schools, leaving students in private schools, youth sports, sports leagues (such as pee wee or little league teams), or club sports unprotected. Others fail to identify staff responsible for enforcing these laws (Potteiger, Potteiger, Pitney, & Wright, 2017). Although not all laws are consistent, the mandate to provide concussion education offers a unique opportunity for nurses to educate students, staff, and coaches in the importance of following safety rules, using proper equipment such as helmets and mouthguards, eliminating horse-play/violence in games/practices, and avoiding bullying (Cook et al., 2017). As advocates, nurses can even encourage rule changes, such as modifying techniques of body contact, including 'heading,' tackling, and checking (McCrory et al., 2013).