Texas lawmakers made it clear just how serious they are concerning concussions among student-athletes with the passing of House Bill 2038, which Governor Rick Perry has since signed into law.
In Stephenville, Mike Carroll has taken concussions seriously for years.
Carroll, the assistant athletic director and head athletic trainer for Stephenville ISD, says the district has for years been ahead of the curve in its concussion management.
The only changes the law meant for Stephenville were the creation of a concussion oversight committee and Carroll being required to present his protocol to the district's board of trustees, which he did this week.
"The law says you have to have an oversight committee and it has to include at least one medical professional who has experience with concussions," said Carroll, who is on the committee along with SISD athletic trainer Kendall Goldberg and a Fort Worth doctor. "No coaches can be on the committee."
The law does not require a concussed athlete to visit the medical professional on that committee, but that professional must take part in the development of the protocol.
Carroll also noted that parents will be required to sign a release before the student-athletes are allowed to resume competition.
"Before the new law, once an athlete satisfied our requirements for returning to play, I would contact the parent and get a verbal OK unless they reported seeing something at home we weren't seeing here," Carroll said. "Now a parent actually has to sign a release form."
A big part of Stephenville's concussion management is the ImPact Test, which Carroll calls a neuro-cognitive test that evaluates important brain activities such as memory composite and reaction time.
"We try to have every athlete in a collision sport like football or a contact sport like basketball, soccer or volleyball take the test so we have a baseline score on them," said Carroll. "If we believe a kid has a concussion, they take the test and it compares their scores."
Carroll said the test cannot be faked because ImPact labels it as invalid if memory answers or reaction-time inputs are inconsistent.
"If that happens, we make them take the test again and it takes about 30 minutes," said Carroll. "Nobody wants to do that."
Once Carroll or medical doctors on site determine an athlete has suffered a concussion, the first step is ensuring there is no possibility he or she can immediately return to the field of play.
"You used to hear of athletes being told to sit out until the headache went away then get back out there," he said. "Not anymore, and certainly not here. If you have a concussion, you're done until you go through all the steps of the protocol.
"We're always going to err on the side of caution," Carroll added. "When in doubt, sit them out."
Carroll said the protocol goes into motion immediately, with the athlete seeing a doctor and taking the ImPact test within 48 hours of being concussed.
"If everything goes well with the doctor and the ImPact Test, they begin gradually returning to the field," he said. "We will have them do light physical activity for 15-20 minutes on their first day back and then progress daily from there. Once a doctor has released them and they've met our requirements, we visit with a parent to be sure no symptoms are being seen at home.
Carroll said a failed ImPact Test that shows an athlete is still concussed means he or she must continue to take it until passing.
In mild concussion cases, Carroll says its quite possible the athlete can satisfy all steps of the protocol and return to the playing field within a week.
"For example, it's possible a football player could get back on the field the next Friday," he said. "But only if we're sure. We're never going to take a risk with kids' health, especially when we're talking about a bruised brain, which is what a concussion is."
Carroll says parents should be sure concussed kids are resting in a cool, dark room when at home and that they refrain from extra cognitive activities such as sending text messages or playing computer or video games.
"If you pull a hamstring you don't treat it by running sprints," Carroll said. "Why would you treat a concussion by adding to the workload of your brain?"
In extreme cases, doctors may be asked to write a note excusing a student from classes.
"If a student is concussed, taking a calculus test probably isn't the best thing for them," he said. "It's just like resting any other part of your body when you're injured. If you're concussed you need cognitive rest."
Carroll ensures parents their children are in good hands.
"We always have at least one certified athletic trainer on hand at athletic events, and in football we have doctors on the sideline who have experience dealing with concussions," he said. "This is something we take very seriously."