Changing the culture of concussion: education meets legislation.

tation Mediedicine, and of Washing, Seattle, WA on Program, Seattle SeSeattle, WA. .H.; e-mail: In October 2006, Zackery Lystedt, an outstanding 13-year-old athlete, was playing in h school football game. With 3 plays remaining at the end of the second quarter, Zack s head on the ground and lay writhing on the field holding his hands to his helmet in distress. An injury time out was called, and Zack was helped to the sideline. After resting minutes during half-time, Zack was returned to the game by his coaches. No medical p were available to assist in that decision-making process (as is typical in middle schoo events). Zack played in the third and fourth quarters but was confused, had difficulty rem the plays, and had a mounting headache. At the end of the game, he collapsed in his fath and was airlifted to a level-1 trauma center. He underwent emergency brain surge life-threatening injuries and survived but with significant neurologic injury and residu ities that affect almost every activity of daily living, including basic self-care, speech, sch and mobility. Certainly, no coach, school administrator, or parent would intentionally place a you at risk for catastrophic injury. Although it is not unheard of that permanent disability death can be associated with youth sports, such tragedies are compounded when preventable. This was the case with Zackery Lystedt. Simply removing him from play a of his first injury would have saved Zack and his family from facing a lifetime of i struggles. However, changing the culture around sports concussions has not been necessarily successful. The challenge is how to change the culture and practice of minim injury that has previously been referred to as a “ding” or “getting your bell rung” to a appreciating that concussions are brain injuries and that all brain injuries can potenti in life-altering consequences. This challenge is even more difficult because most ath experience sports concussions appear to recover without readily apparent consequen ever, this is not always the case. The idea that all sports concussions should be taken seriously is not new. The C Disease Control (CDC) created a now long-standing educational program, known as “H Concussion in Youth Sports,” that provides free concussion tool kits, posters, clip bo sheets, videos, and DVDs to athletes, parents, and coaches. More recently, many materials have become available through free downloads, and the CDC has even develo online concussion education course for coaches (and soon will be launching one for h providers). These well-established and updated educational efforts demonstrate t leadership continues to view sports concussions as a major public health issue. In th health care community as well, the idea that proper management of sports concussi important matter is certainly not new. For well over a decade, the opinion that the diag treatment of sports concussions (including providing clearance for return to play) is issue has been articulated in numerous national and international concussion consen ments [1-4]. The tragedy that befell Zack Lystedt and his family painfully identified that the pub and medical management messages about youth sports concussions were not always their intended audiences. A confluence of circumstances provided the opportunity to re message and implementation of youth sports concussion management. Zackery’s story each of us in separate and overlapping ways as a legal counsel and community cham survivors of traumatic brain injury and as a physiatrist and advocate for proper you concussion medical management. The Brain Injury Association of Washington teamed the CDC and launched a “Heads Up” concussion awareness program for youth athletes in