With the signing into law by Governor Nathan Deal of Georgia's new concussion safety law, forty-five states and the District of Columbia [1] have now enacted strong youth sports concussion safety laws since May 2009, all modeled on Washington State's groundbreaking Zackery Lystedt Law [2]:

1. Alabama; [3]
2. Alaska [4];
3. Arizona [5];
4. California [6]; (amendment  [7]being considered would extend coverage of law to charter schools and private schools)
5. Colorado [8];
6. Connecticut; [9]
7. Delaware [10];
8. Florida; [11]
9. Georgia [12]**;
10. Hawaii [13];
11. Idaho [14];
12. Illinois [15] (a bill [16] limiting full-contact practices during the season to once a week has been introduced in the state legislature); [15]*
13. Indiana [17] (bill proposing to expand coverage of Lystedt law to all youth sports sent for further study by legislature [18]);
14. Iowa [19];
15. Kansas [20];
16. Kentucky [21];
17. Louisiana [22];
18. Maine [23];
19. Maryland [24] (legislature adjourned 2013 session without acting on bill [25] - later withdrawn - that would have required protective head gear in girls' lacrosse, and a measure to limit and regulate the amount of contact allowed in high-impact school sports) ;
20. Massachusetts;
    [26]
21. Michigan [27];
22. Minnesota [28];
23. Missouri [29];
24. Montana [30];
25. Nebraska [31];
26. New Hampshire [32] (on April 19, 2013, a bill passed [33] expanding coverage to intramural sports and from grades 9 to 12 to grades 4 through 12; the bill is awaiting the governor's signature);
27. New Jersey; [34]
28. New Mexico; [35]
29. New York; [36]
30. Nevada; [37]
31. North Carolina [38];
32. North Dakota [39];
33. Ohio [40] (see photograph of signing ceremony at right);
34. Oklahoma; [41]
35. Oregon [42] (bill  [43]expanding coverage by requiring parents and student-athletes aged 12 and older to sign concussion information sheet as condition of participation and beyond schools passed by Senate on April 8, 2013, currently being considered in the Oregon House). 
36. Pennsylvania; [44]
37. Rhode Island [45] (a proposed [45]amendment [46] to the state's law would broaden the scope of those medical professionals who can diagnose and manage a student-athlete's concussion; have all student-athletes undergo baseline neurocognitive tests prior to the start of every sport season; and require coaches/volunteers to complete an annual refresher course);
38. South Dakota; [47]
39. Tennessee [48]
40. Texas [49] (a bill requiring baseline neurocognitive testing and limiting full-contact practices during the season to one a week was recently introduced [50] in the state legislature);
41. Utah [51];
42. Vermont [52] (amendment [53] close to passage would require school athletic coaches and referees to receive training on how to prevent concussions; prohibit a coach or an AT from allowing an athlete to continue playing if the trainer knows or should know that the athlete has sustained a concussion; require that a health care provider be consulted if a coach and an AT do not agree on whether an athlete has sustained a concussion; and require the home team to ensure that a licensed AT or health care provider is present at any athletic event involving a contact sport);
43. Virginia (proposed amendments [54] to the state's law would broaden the scope to cover all youth sports leagues, not just school sports) [55]
44. Washington [2]; and
45. Wisconsin [56].

One state (Wyoming [57]) has enacted a weak sports concussion safety law that does not fully protect youth athletes in that it fails to include one or more of the three principal components of the Zackery Lystedt law [2]:

• Inform and educate youth athletes, their parents and guardians and require them to sign a concussion information form;
• Removal of a youth athlete who appears to have suffered a concussion from play or practice at the time of the suspected concussion; and
• Requiring a youth athlete to be cleared by a licensed health care professional trained in the evaluation and management of concussions before returning to play or practice.

[59]

Arkansas

While Arkansas does not have a stand-alone youth sports concussion safety law, under a bill signed into law by Governor Jay Beebe in the spring of 2011 (ACT 1214 [60]), the state requires high school coaches in the state to undergo training every three years to prevent and treat exertional heat illnesses [61], dehydration [62] and medical emergencies, concussions, and dangerous environmental issues and communicable diseases (such as MRSA [63]), including training on how to educate parents on sports safety issues, and requires school districts in the state to develop procedures for dealing with these safety issues.

Under guidelines issued by the Arkansas Activities Association, the state's governing body for high school sports, student-athletes suspected of having suffered a concussion must be removed from play immediately, cannot return to play within 24 hours after concussion, and only then after obtaining a written release from a medical professional current in concussion management clearing the athlete to begin a mandatory 5-day graduated return to play protocol.

"We felt instead of passing legislation on each and every issue that we would do a comprehensive bill," said Jason Cates, ATC/LAT, President of the Arkansas Athletic Trainers' Association. In an email to MomsTEAM, Cates said he was "beyond frustrated, at publication after publication making us look like [Arkansas was] sitting on our backsides doing nothing. We just went at it a different way." In fact, Cates says, he hears from his peers "all the time saying they wished they would have followed [Arkansas'] blue print."

The problem with "guidelines," of course, is that they don't have the force of law. 

Dwindling number of hold-outs

Of the five states without strong youth sports concussion safety laws, the West Virginia [64] legislature has passed a bill including all three elements of the model Lystedt law and it is expected to be sent to the governor for signature soon; a bill is moving towards passage in South Carolina [65]; in Arkansas, a law [66] appropriating $1 million for a pilot concussion management project recently became law, but, as noted above, the three elements of the Lydstedt law have been enacted as rules by the state high school athletic association; and Wyoming, also as noted above, has a concussion safety law, but it does not include all three Lystedt elements.***  That leaves Mississippi as the only state in the country without any legislation or athletic association rule on concussion safety, enacted or pending (three different concussion bills (HB1284 [67], HB1558 [68], and SB 2228 [69]) all  [67]died in committee during the 2013 legislative session).

For statistics about concussions in high school sports, click here [70].

For myths about concussions, click here [71].

* The Illinois law differs slightly from the model Lystedt Law in its approach: the law directs the Illinois High School Association to set guidelines on concussion management which parallel the three key provisions of the Lystedt Law. As a result, some websites, including MomsTEAM, count Illinois; some others don't. 

** The new Georgia goes one step further than most state laws by extending the Lystedt requirements to private schools, charter schools, and youth sports outside of school. The same is true of the new Tennessee [48] and Montana [30] laws.

*** Some websites [72] count Wyoming and Arkansas in their totals, bringing the total to 47.  

Sources: Numerous, including National Coalition on Youth Sport Concussion, Safe Kids USA, NFL Health and Safety [73] and the National Athletic Trainers' Association and the Network for Public Law [74] (citations to, and excellent summary, of each individual state law), and Education Week [75]; and American Academy of Physical Medicine and Rehabilitation (which has an excellent pdf [76] tracking legislative developments)

Most recently updated May 14, 2013

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