Reducing Traumatic Brain Injuries - Research Paper Example

?Public Health Issue Overview of the Health Problem Traumatic brain injuries (TBIs) have received increased awareness from the public especially those injuries resulting from the participation in recreation and sports activities. The increased public awareness has made the federal and the state governments to implement or consider laws that direct the response to alleged brain injury (Centers for Disease Control and Prevention [CDC], 2011). Concussion is a form of TBI and CDC (2010) states that it is caused by a blow, jolt, or a bump to the head. It can also occur from a blow to the body or from a fall, that leads to quick back and forth movement of the brain and the head (CDC, 2010). The National Conference of State Legislatures (NCSL, 2011) defines TBI as an interruption of the normal brain functioning due to a jolt, bump, blow, or a penetrating head injury. It is estimated that each year, approximately 1.7 million people suffer from TBI (traumatic brain injury). The major causes of traumatic brain injury include motor vehicle crashes, falls, or being struck against or by assault and objects. Majority of these injuries are mild and they result into a short-term interruption like a concussion. On the other hand, some of the injuries may be severe resulting in amnesia or prolonged unconsciousness and they rarely lead to death or permanent disability (NCSL, 2011). Severity of the Problem It is estimated that 300,000 sport-associated traumatic brain injuries occur every year in the United States; the most predominant traumatic brain injury is concussion. The most dominant causes of traumatic brain injuries among young people of the ages between 15 and 24 years are motor vehicle crashes and sports. Researchers agree that concussions are serious injuries occurring frequently among the young people. Studies conducted on collegiate and high school athletes indicate that cumulative impacts may result from a number of (three or more) concussive episodes. The frequency of these concussive episodes stress the seriousness of concussions that are sport related. The participation of students in collegiate and high school sports is increasing. Statistics show that between 2005 and 2006 more than seven million high school students took part in sports and close to 385,000 collegiate students participated in sports activities. Thus, if preventive measures are not implemented, the number of student athletes who may sustain a concussion may also increase. However, there are areas that have not been well understood by the researchers in relation to sport-related concussions. Thus, researchers have presented different findings. For example, the relationship of factors such as the level of competition and sex with concussion is not well understood. Some authors have indicated that the occurrence of concussions among the high school athletes is higher and takes a long to recover compared to collegiate athletes. Researchers have also presented differing evidence and they suggest that the occurrence of concussions may be more at the collegiate level. The focus by many researchers comparing concussion occurrence and recovery among the collegiate and high school athletes is on football and little attention has been given to other female sports or male sports (Gessel et al., 2007). According to CDC (2010), the severity of TBI ranges from mild to severe (mild refers to a short change in consciousness or mental status and severe refers to a prolonged period of amnesia or unconsciousness after the injury. Traumatic brain injury can lead to various functional short-term or long-term changes that affect sensation (smell, taste, and touch), emotions (social inappropriateness, aggression, depression, acting out, personality changes, and anxiety), thinking (reasoning and memory), and language (understanding, communication, expression). Traumatic brain injury can also lead to epilepsy and raise the risk for conditions like Parkinson’s disease, Alzheimer’s disease, and other forms of brain disorders that become more established as the individual ages (CDC, 2010). It is estimated that close to 75 per cent of the traumatic brain injuries that occur annually are concussions or other types of traumatic brain injuries. Repeated “mild TBIs occurring over an extended period of time (i.e., months, years) can result in cumulative neurological and cognitive deficits. Repeated mild TBIs occurring within a short period of time (i.e., hours, days, or weeks) can be catastrophic or fatal” (CDC, 2010). Other long-term consequences include memory difficulties, headaches, irritability, dizziness, attention deficits, personality changes, and sleep disturbances. However, the effects depend on the severity or the extent of the injury. For instance, Grade III concussions patients (patients who have lost consciousness) or Grade II concussions are vulnerable to long-term problems (Daniel, 2010). If no intervention is implemented, the above-mentioned consequences can occur to an individual who has suffered a traumatic brain injury. There are cases where the individual can suffer second impact syndrome resulting from partial recovery of initial concussion. According to Daniel (2010), experts estimate that close to 40% of the athletes concussed went back to the field before they fully recovered from concussions; thus, making them vulnerable to second impact syndrome. Second impact syndrome is potentially fatal and more severe condition that happens when an individual with a concussion gets another blow before he or she fully recovers from the initial concussion (Daniel, 2010). It is important to note that athletes and coaches frequently fail to recognize that time is required before an athlete fully recovers from concussion symptoms. However, the incidence of second impact syndrome is low and it is most likely to happen in high school athletes (Morris, 2007). Overview of the Bill and Stakeholders The bill AB 1646 (as suggested to be amended), extends the existing coach’s CPR (cardiopulmonary resuscitation) and first aid training requirements to comprise the recognition of symptoms, signs, and proper steps for dealing with severe injuries (including concussions). What looks like a slight blow to the head can result to serious and at times fatal outcomes. Emerging studies suggest that “high school athletes are at risk of suffering from sleeping disorders, memory loss, mental fatigue, depression or even suicide as a result of head injuries sustained in sports” (Office of Assemblywoman Mary Hayashi, 2010). Not all the head injuries can be avoided but the effects can be alleviated through knowing the safest time to return to play. Presently, certification in first aid and CPR are the only necessary injury-related training required for high school coaches in the state of California. AB 1646 bill integrates concussion training into the mentioned existing requirements (Office of Assemblywoman Mary Hayashi, 2010). AB 1646 integrates the following provisions into the existing high school coaches training requirements: a) Determination of symptoms and signs of potentially dangerous injuries such as concussions, asthma attacks, cardiac arrest, second impact syndromes, heatstroke, and head and neck injuries. However, the provision is not limited to the mentioned dangerous injuries. b) Effective communication with the emergency services, and c) Learning the proper emergency action planning (Office of Assemblywoman Mary Hayashi, 2010). The training requirement would be incorporated as the coaches renew their first aid and CPR certification. The necessity imposed by the bill for the coaches to complete the additional training would require an imposition of a state-mandated local program. The California constitution necessitates the state to compensate the school districts and local agencies for particular costs authorized by the state (eLobbyist, 2011). Promises/Expected Outcomes Stepanov (2010), states that the bill aims at adding precautionary measures to guarantee the safety of the young athletes. The representatives of the bill Mary Hayashi and Jerry Hill are in collaboration with California Athletic Trainers Association (CATA) to make sure that the bill passes. Other lobbyists include the Senator of California, Tony Strickland and he is among the co-authors of this bill. Other individuals working in the office of Mary Hayashi are of the opinion that there must be improvement on the awareness of sport safety. They further state that the bill stresses the idea that sports injuries can result in severe consequences. Safety in sports is a continuous evolutionary practice just like the equipments used in these sports (Stepanov 2010). The main intention of the bill is to offer the high school coaches a plan or a program to become more knowledgeable on matters pertaining to sports injuries. The coaches are required by the California Interscholastic Federation to learn first aid and CPR. However, the bill requires that the coaches get specialized education on the potential dangerous injuries. An athletic trainer asserts that the training will be important since the potential of a catastrophic injury is real in all sports. Knowledge about the athlete’s personality and his or her condition is important in the assessment of an injury. The athletic trainer indicates that all head injuries are not the same and majority of the high school do not possess personnel to determine the symptoms that indicates a significant brain trauma (Stepanov 2010). Most of these concussions cannot be spotted easily and thus there is need to emphasize for better procedures to assist in the diagnosis of head injuries and “get players out of games during the post-concussion period, when there is the greatest risk for more injuries” (Maclachlan, 2010). Problems The State of California Assembly indicates that it will support the bill if it is amended to incorporate a provision that the high school athletic coaches or the school district employees would not be held accountable for civic damages if they render an emergency treatment or care in an athletic event. The bill requires that the high school athletic coaches renewing or getting certification in first aid to take additional training that entails general understanding of the symptoms and signs of potentially dangerous injuries such as cardiac arrest, asthma attacks, concussions, heatstroke, head and neck injuries, and concussions. The requirement for the high school coaches to accomplish the additional training means that the bill will enforce a state-mandate local program (Schools Excess Liability Fund, 2010). Unintended Consequences If the bill is not amended as requested by the State of California Assembly, it would mean that the high school athletic coaches and the school district employees would be held responsible for civic damages if they offer an emergency treatment or care to an athlete at an athletic event. The bill fails to recognize catastrophic injuries that occur during practices. Therefore, there is need for the schools to have certified athletic trainers during practices; this is because most of the deaths and serious injuries occur during practices (Maclachlan, 2010). Apart from athletes, there are important people who are not covered by the bill and this indicates that the bill covers only the athletes. This group of people is the cheerleading group. Although the California Interscholastic Federation has implemented a rule requiring an athlete assumed to have sustained a head injury or a concussion to be removed from the game or practice for a whole day (Daniel, 2010), the risks of getting a second impact syndrome are high. The lack of the proposed additional training for the high school coaches will lead to poor judgment of athletes suffering from concussions. As stated before, athletes and coaches fail to recognize that time is needed before an athlete fully recovers from concussion (Morris, 2007). If the bill is not implemented, cases of second impact syndrome may increase significantly. Thus, the proposals made in the bill will come a long way in reducing both concussions and second impact syndromes among high school athletes. Cheerleading is now considered very dangerous than any other sports. In the past 25 years, high school cheerleading accounted for approximately 65.1% of all the dangerous sports injuries, particularly among the high school females. Closed head injuries and concussions account for 3.8 percent of the catastrophic injuries. The main contributing factor to the increase in these catastrophic injuries is the shifts in the cheerleading activities; the present cheerleading activities involve gymnastic-like stunts. Another contributing factor is that experienced coaches do not teach these cheerleading activities and they are increasing in difficulty (LiveScience Staff, 2008). Cheerleading is not considered a sport by most states; it is considered an activity just like clubs (Stein, 2008). Thus, if cheerleading is not incorporated into the bill, there might be a rise in catastrophic injuries at the athletic events since athletes and cheerleaders are all involved in most of the high school athletic events. Recommendations The aim of the bill is to reduce incidences of catastrophic injuries at athletic events through the addition of precautionary measures to guarantee the safety of the young athletes. However, the bill must consider other things since athletes are not the only ones at risk of catastrophic injuries at an athletic event. The bill should incorporate cheerleading groups; this is because there are reported cases of dangerous injuries such as closed head injuries and concussions among these high school cheerleaders. An experienced coach must train the cheerleading groups and it should be considered a sport activity since they have incorporated gymnastic-like stunts (LiveScience Staff, 2008). The bill must also assure the high school athletic coach and the district employee that he or she will not be a liable for a civic damage in case the coach or the employee renders an emergency care or treatment. This is because the coaches and the employees would have been trained to attend to such cases as proposed by the bill. The bill proposes that the high school coaches be trained on recognize and deal with catastrophic injuries but it has not stated if the coach will be liable for a civil damage if he or she administers emergency care or treatment (Office of Assemblywoman Mary Hayashi, 2010). Thus, clarification of the matter will alleviate any fears related to the administering of emergency care or treatment. References Centers for Disease Control and Prevention. (2010). Concussion. Retrieved from http://www.cdc.gov/concussion/get_help.html Centers for Disease Control and Prevention. (2010). What are the potential long-term outcomes of TBI? Retrieved from http://www.cdc.gov/TraumaticBrainInjury/outcomes.html Centers for Disease Control and Prevention. (2011). Nonfatal traumatic brain injuries related to sports and recreation activities among persons aged ? 19 years --- United States, 2001 – 2009. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6039a1.htm?s_cid=mm6039a1_w Daniel, P. K. (2010, July 20). Schools take aim at brain injuries. The San Diego Union-Tribune. Retrieved from http://injuredathletes.org/pdfs/clips/072010SDUT.pdf eLobbyist. (2011). Bill text: CA Assembly bill 1646 – 2009-2010 regular session. Retrieved from http://e-lobbyist.com/gaits/text/6448 Gessel, L. M., Fields, S. K., Collins, C. L., Dick, R. W., and Comstock, R. D. (2007). Concussions among United States high school and collegiate athletes. Journal of Athletic Training, 42(4), 495-503. LiveScience Staff. (2008, Aug. 11). Girls’ most dangerous sport: Cheerleading. LiveScience. Retrieved from http://www.livescience.com/2775-girls-dangerous-sport-cheerleading.html Maclachlan, M. (2010, Jan. 14). Hayashi to introduce pair of bills to protect kids who play sports. Capitol Weekly. Retrieved from http://www.capitolweekly.net/article.php?xid=yk130nloq6d7dg Morris, L. (2007, Dec. 10). Effects of second impact syndrome in high school athletes. ColumbiaGeorgia Online. Retrieved from http://www.columbusgeorgiaonline.com/health8.htm National Conference of State Legislatures. (2011). Traumatic brain injury legislation. Retrieved from http://www.ncsl.org/?tabid=18687 Office of Assemblywoman Mary Hayashi. (2010). Assembly bill 1646 (Hayashi) catastrophic injury training for high school coaches. Retrieved from http://www.calbia.org/_literature_48699/AB_1646_Fact_Sheet Schools Excess Liability Fund. (2010). Bill update. Retrieved from http://www.selfjpa.org/resources/legislation/2010/Leg2Web10.pdf Stein, R. (2008, Sep. 19). Sports injury research: Cheerleading riskier than football. Missourian. Retrieved from http://www.columbiamissourian.com/stories/2008/09/19/sports-injury-research-cheerleading-riskier-football/ Stepanov, M. (2010, Feb. 9). Legislation aims to improve safety for young athletes. The California Aggie. Retrieved from http://www.theaggie.org/2010/02/09/legislation-aims-to-improve-safety-for-young-athletes/ Read More