Looking into the Lystedt Law

Submitted by the Tribune on October 14, 2009 - 8:08am. Sports
Lynden Tribune, Lynden, Washington
Caleb BreakeyTribune sports reporter
 
Lynden Christian and Nooksack Valley personnel move LC player Peter Larsen onto a stretcher after he suffered a hard hit to the head on Oct. 2. Larsen was able to speak as he was taken to St. Joseph Hospital in Bellingham. His injury represents one of the many reasons why the Lystedt Law was enacted this summer. — Lynden Tribune | CALEB BREAKEY
WHATCOM — Andrew Fremont Swank of Valley Christian School in Spokane died on Sept. 27 at the age of 17 after suffering a severe head injury during a football game, leaving behind his parents, four sisters and three brothers.
Someone’s child. Someone’s football player. This raises a sensitive, yet extremely important, topic in Whatcom County — which both loves its children and loves its football.
Consider this study from Boden et. al. (2007) in the American Journal of Sports Medicine: 39 percent of all athletes at the time of a catastrophic (death or paralysis) injury were playing with residual symptoms from a previous concussion. Fifty-nine percent of those athletes had a previous history of concussions, and 71 percent of those injuries occurred in the same season as the catastrophic injury.
Because of this research and research like it, Washington State enacted the Lystedt Law this past summer, a law named after Zackery Lystedt, who suffered brain damage while playing football for Mount Tahoma Junior High School.
The law, which applies to athletes on all public fields and in all leagues, states that no players shall return to play with any suspected head injuries without an evaluation. So, when it comes to small schools that can’t afford an athletic trainer at all games, in theory, the moment a player mentions that his head hurts, the coach is obligated to pull the player out.
To Duane Korthuis, Lynden athletic trainer and sports medicine instructor, the statistics above say two things: 1) That no one should be playing with any symptoms of a head injury; and 2) That first-time concussions cannot be prevented from happening, but, at the same time, schools can most certainly reduce the number of catastrophic injuries by letting the first one heal properly.
“Concussions are a serious thing. A ding is not just a ding,” Korthuis said.  As much as a topic of life-or-death would seem black or white, the Lystedt Law is anything but simple. There is plenty of confusion over both the law and what even defines a concussion.
Boiled down in its truest form, the law is to protect football players. That, Korthuis said, is important to keep in mind because every person this law affects must realize that everyone is on the same page: the safety of the athletes.
But, as with every law, these new regulations hit different people and different sides in different ways.“There’s going to be good and bad that comes out of a law like this,” Korthuis said. “People love sports. If a kid has head injury symptoms, we’re now able to take that return-to-play decision off of the coach and put it on a health care provider who knows head injuries.”
Finding a Balance
As far as the medical side of the equation goes, Korthuis said he and other medical personnel are not doing anything different in terms of treatment to head injuries. Instead, the Lystedt Law is a policy which places responsibility onto the shoulders of many.
The Washington Interscholastic Activities Association (WIAA) recognizes the following healthcare providers as having necessary education and licensure to assess and manage head injuries: Medical Doctor, Athletic Trainer, Advanced Registered Nurse Practitioner, Physicians Assistant and Doctor of Osteopathy.
Korthuis used the analogy of drunk driving when talking about the law. He noted that, in the past, police officers would rely almost solely on having people walk on lines and answer questions to determine a drunk driver. Now, however, Breathalyzers are used. It’s a more objective way to test.
“Thirty years ago we were letting people drive drunk and not knowing,” Korthuis said. “Now we know if you have a .08, you shouldn’t be driving. If you follow that analogy, why don’t we set the limit at .04? We could eliminate more drunk driving, but we say we’re willing to live with a little bit of risk.
“We don’t want to make it so people can’t feel free that they had a drink yesterday and can’t drive for a week (or what have you). So you pick a risk you can live with. We’re trying to find a healthy balance. There’s been a lot of kids who have had head injuries, and the worst ones come from when they have had concussions in the past or if they’re playing with symptoms.”
This is where things tend to get murky because, yes, in a perfect world, why not lower the alcohol limit to .01? And why not pull athletes out of games the second they feel so much as a twinge of any pain above the neck?
It comes down to that level of “risk” Korthuis noted. All sides of the issue struggle with finding the line of what the law should accomplish and what in reality we as humans will allow, risk-wise — including medical personnel.
“First off, we have to remember that while sports are a vital part of growing up we need to keep things in perspective,” said Christine Nelson, athletic trainer at Lynden Christian. “Head injuries can have serious long-term repercussions. There will most definitely be times when physicians differ on their approach and diagnosis. Since this is a new law … everyone is learning and adjusting along the way. I think most everyone is fairly conservative in their approach and rightfully so.”
Caution
Still, though, Korthuis points to Lynden football coach Curt Kramme, whose colleagues and players herald as extremely cautious about head injuries — a coach who won’t let his players step back on the field until he sees a doctor’s note.
Even someone cautious could be held accountable if he were to err ona decision. And, for quite a handful of schools, the decision sits on the coach’s shoulder because many do not have certified men or women who can evaluate players on the spot.
“A team like ours with an athletic trainer can say, ‘Yeah, you’re good, you can play,’” Korthuis said. “Another team might not have that. And they have that law looming in their minds.
“I think there’s some relief on one end,” Korthuis said. “You get it from all ends of the spectrum. Parents think: ‘Oh good. Someone is looking after my kids.’ But you also get the frustration of, ‘I’m really being held to a paper trail of if someone got marked off by a professional.’ During a game it can be difficult because … can this person be cleared right now?”
What can make things more complicated is that young players who want to play just might hide information from their coaches. And that’s a scary fact. Korthuis said it doesn’t take much of a hit to hurt an athlete already showing symptoms.
“I think the greatest risk to the coaches is if they choose to ‘overlook’ the law as it is written,” Nelson said. “Most of our schools do not have athletic trainers and as such, things don’t change much on that count. Kids will still need to be seen and cleared by a medical professional prior to returning to their sport.”
Again, the issue seems to come down to this, Korthuis pointed out: Are we going to base the strictness of the law on one or two events, or should the injuries be prevented completely by absolute avoidance at the first sign of any head trauma of any kind?
“What’s the balance?” Korthuis said. “We’re still working on that, and communication is key between athletes, coaches, parents and healthcare providers.”
To cast a wide net, Korthuis described one of the generalizations central to the argument of how the Lystedt Law should be enforced.
“In a practical way, it’s the difference between some moms and dads watching football,” Korthuis said. “Mom says (the athlete shouldn’t) play if he gets hurt. And dad says it will make (the athlete) a man.“A generalization for sure, but that’s the issue — how much risk are we willing to take? I have the medical side of me saying, at what cost? I can see both sides, too. I would never want to clear someone and have it turn out bad. But I also don’t want to be the bad guy and say ‘Can’t play … can’t play … can’t play.’”
Injuries
Head injury symptoms do not mean that an athlete has to be unconscious to have a concussion. Less than 10 percent of head injuries involve a loss of consciousness, Korthuis said.Head injuries are simply a software problem, not a hardware problem — they are rarely visible.
And that’s where athletic trainers and people certified to clear athletes to hit the field again come into play.“Players can have trouble thinking, you can see it. There’s a problem,” Korthuis said. “You check if they have a headache, if their nauseous, if they have ringing in their ears. There are three primary areas to check: symptoms, memory and balance. A person can’t lie about memory and balance because it can be objectively tested.”
But, as Korthuis noted, the athletes may lie about those symptoms because they might not want to come out of the game — especially considering the toughness associated with the gridiron sport.
Some parents or former football players might be quick to say that they played with headaches their entire career, but Korthuis says: “Well, that person may be one of the guys who made it, luckily. Others didn’t make it (because they) played with symptoms.”
So, for men and women tasked with evaluating the players, it’s not about just hearing from a player’s mouth that he is okay.
“You have to figure out if the brain is functioning well,” Korthuis said. “Concussions typically don’t show up on Cat Scans or MRIs. A concussion in most people’s mind is they must be lying on the field, lifeless (which is absolutely false).”
Most athletes who have concussions tend to get at least a week off. Korthuis noted that some doctors will give a set time of seven days before an athlete can hit the field again, but Korthuis said it’s imperative to continually reevaluate the symptoms to make sure the athletes have fully recovered.
“It’s when the signs and symptoms go away,” Korthuis said. “And it’s a graded return. Try running, jogging, and if that brings back symptoms, then the problem is not gone yet.”
There isn’t necessarily one great test that fits with all the athletes, Korthuis said.  So the discussion continues in next week’s Tribune, when we delve into the point of views of coaches, athletes and athletic directors…“I think this is a very sensitive subject and one which is going to continue to define itself more clearly as time goes on,” Nelson said. “In the end, the most important thing is remembering that these are young lives and young brains that we are dealing with and we need to protect them at all costs.”
E-mail Caleb Breakey at sports@lyndentribune.com.