BILL ANALYSIS                                                                                                                                                                                                    



                                                                  AB 588
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          Date of Hearing:   May 8, 2013

                           ASSEMBLY COMMITTEE ON EDUCATION
                                Joan Buchanan, Chair
                   AB 588 (Fox) - As Introduced:  February 20, 2013
           
          SUBJECT  :   School Athletics: Concussions

           SUMMARY  :   Applies existing law relating to students who  
          sustain, or are suspecting of sustaining, a concussion during a  
          school-sponsored athletic activity to private schools and  
          requires specified information be provided to athletes and the  
          athlete's parent or guardian regarding concussions.  
          Specifically,  this bill  :  

          1)Makes applicable to private schools existing law that requires  
            a school district that chooses to offer an athletic program to  
            immediately remove an athlete who is suspected of sustaining a  
            concussion or head injury from the activity for the remainder  
            of the day and prohibits the athlete from returning to the  
            activity until he or she is cleared by a licensed heath care  
            provider.

          2)Makes applicable to private schools existing law that requires  
            a school district that chooses to offer an athletic program to  
            require each athlete and each athlete's parent/guardian to  
            sign and return a concussion and head injury information sheet  
            prior to the athlete participating in practice or competition.

          3)Specifies that the concussion and head injury information  
            sheet contain, at minimum, information regarding concussions  
            and their symptoms.  

          4)Allows the concussion and head injury information sheet be  
            made available digitally (e.g. e-mail or on an Internet  
            Website).

           EXISTING LAW  

          1)Requires each high school sports coach to complete a coaching  
            education program developed by his or her school district or  
            the California Interscholastic Federation (CIF) that meets the  
            guidelines set forth by the High School Coaching Education and  
            Training Program (HSCETP).  









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          2)Requires a school district that elects to offer an athletic  
            program to comply with all of the following:

               a)        An athlete who is suspected of sustaining a  
                    concussion or head injury in an athletic activity  
                    shall be immediately removed from the activity for the  
                    remainder of the day.

               b)        An athlete who is suspected of sustaining a  
                    concussion or head injury in an athletic activity  
                    shall not be permitted to return to the activity until  
                    he or she is evaluated by a licensed health care  
                    provider, trained in the management of concussions,  
                    acting within the scope of his or her practice.  The  
                    athlete shall not be permitted to return to the  
                    activity until he or she receives written clearance to  
                    return to the activity from that licensed health care  
                    provider.  

               c)        On a yearly basis, a concussion and head injury  
                    information sheet shall be signed and returned by the  
                    athlete and the athlete's parent or guardian prior to  
                    the start of the athlete's season of practice or  
                    competition.  

          3)Exempts an athlete engaging in an athletic activity during the  
            regular school day or as part of a physical education course  
            from these requirements. 

           FISCAL EFFECT  :   This bill is keyed as nonfiscal by Legislative  
          Counsel

           COMMENTS  :   Concussions have serious immediate and long-term  
          effects.  A concussion is a brain injury caused by a blow to the  
          head or body or from hitting a hard surface, and in only 10% of  
          cases is it evident from loss of consciousness.  

          Under existing law, the CIF is a voluntary organization  
          consisting of school and school-related personnel with  
          responsibility for administering interscholastic athletic  
          activities in secondary schools.  CIF policy ensures  
          student-athletes do not return to practice or competition until  
          evaluated by a healthcare professional; however this only covers  
          about 1 million students between 14-18 years old.  Existing law  
          already widened the students to whom this policy applies by  








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          including the 3 million students between 6-14 years old playing  
          non-CIF youth sports in public schools.   This bill  further  
          extends this policy to those students ages 6-18 participating in  
          non-CIF athletic programs in private schools.

          The committee recommends amending this bill to add charter  
          schools to the entities to which this section applies, to ensure  
          that all California students are protected. 

          This bill also ensures that all K-12 athletes, whether attending  
          a private or public school, and their parents are aware of the  
          signs and symptoms of a concussion in order to prevent further  
          injury.  According to the author, by specifying the content of  
          the information to be provided to athletes and their  
          parent/guardian, there will be an increased awareness of the  
          signs and symptoms of serious head injuries, especially for  
          young athletes who are more vulnerable to greater injury.  This  
          increased understanding provides youth participating in  
          athletics with safeguards against long-term injuries that result  
          from concussion and head injury, helps parents advocate for  
          their children when these health issues arise, and assists  
          parents in managing head injury outside of school.  

          Awareness of concussions is an important first step in curbing  
          the alarming number of these injuries that are suffered each  
          year.  In a 2012 study by Dr. Mallika Marar, published in the  
          American Journal of Sports Medicine, among high school  
          student-athletes across the United States "over the course of  
          the 2008-2010 school years, 14,635 injuries were reported, 1936  
          (13.2%) of which were concussions. This included 1289  
          concussions (66.6%) that occurred in competition and 647 (33.4%)  
          that occurred during practice." While awareness is not  
          prevention, it is critical in preventing student-athletes from  
          suffering further injuries by returning to play too soon.  
          According to the CIF's website:
                    Continuing to play with the signs and  
                    symptoms of a concussion leaves the young  
                    athlete especially vulnerable to greater  
                    injury. There is an increased risk of  
                    significant damage from a concussion for a  
                    period of time after that concussion occurs,  
                    particularly if the athlete suffers another  
                    concussion before completely recovering from  
                    the first one. This can lead to prolonged  
                    recovery, or even to severe brain swelling  








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                    (second impact syndrome) with devastating  
                    and even fatal consequences. It is well  
                    known that an adolescent or teenage athlete  
                    will often under report symptoms of  
                    injuries, and concussions are no different.  
                    As a result, education of administrators,  
                    coaches, parents, and students is the key  
                    for the student-athlete's safety. 

          Working together, athletes, coaches, and parents can increase  
          awareness and treatment.  Additionally, this bill promotes easy  
          access to these materials by specifying that a school may  
          provide these materials to athletes and their parents via email  
          and post the information on the school's website.

          The author has committed to work with the California Medical  
          Association to address the following two concerns raised in  
          their letter of conditional support:
             1)   Specifying the appropriate training necessary to provide  
               the health assessment called for in this section; and
             2)   Examining the broad exclusion of all athletic activities  
               that occur during the regular school day.

           Previous Legislation  :  AB 1451 (Hayashi), Chapter 173, Statutes  
          of 2012, includes a basic understanding of the signs and  
          symptoms of concussions and the appropriate response to  
          concussions within the HSCET, administered by school districts.

          AB 25 (Hayashi), Chapter 465, Statutes of 2011, requires a  
          school district that elects to offer athletic programs to  
          immediately remove from a school-sponsored athletic activity for  
          the remainder of the day an athlete who is suspected of  
          sustaining a concussion or head injury during that activity;  
          prohibits the return of the athlete to that activity until he or  
          she is evaluated by, and receives written clearance from, a  
          licensed health care provider; requires, on a yearly basis, a  
          concussion and head injury information sheet to be signed and  
          returned by the athlete and the athlete's parent or guardian  
          before the athlete's initiating practice or competition. This  
          measure was passed out of this committee by a vote of 9-0.

          AB 1449 (Hayashi) (2012), requires the SPI to develop and make  
          available a concussion and head injury information sheet that a  
          school district could use to satisfy the requirements of  
          Education Code section 49475.   








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          AB 1646 (Hayashi) (2010), held in the Assembly Appropriations  
          Committee suspense file, requires training for coaches to be  
          able to identify symptoms of head and neck injury.  This measure  
          was passed out of this committee by a vote of 6-2.

          AB 1647 (Hayashi) (2010), establishes certification and training  
          requirements for athletic trainers.  The bill also prohibits  
          individuals from calling themselves athletic trainers unless  
          they met those requirements.
          Governor Schwarzenegger vetoed this bill with the following  
          message:  

               This bill is similar to legislation I have vetoed twice  
               before in the past because there is no evidence that  
               regulating the use of the term "certified athletic trainer"  
               poses any threat to the public health and safety.

          AB 1893 (Hayashi) (2010), held in the Assembly Education  
          Committee, requires all high school spirit activities coaches to  
          have valid certification in CPR and first aid, including an  
          understanding of signs, symptoms, and appropriate emergency  
          action steps regarding potentially catastrophic injury,  
          including but not limited to, head and neck injury and  
          concussion.  Pupils participating in this activity who  
          experience or show signs of trauma or other injury must obtain a  
          release from the treating provider before resuming these  
          activities.  

          AB 533 (Hayashi) (2009), held in the Assembly Appropriations  
          Committee suspense file, requires training for coaches to be  
          able to identify symptoms of head and neck injury.  This measure  
          was passed out of this committee by a vote of 8-1.

           REGISTERED SUPPORT / OPPOSITION  :   

           Support 
           
          California Medical Association (support if amended)
          Emergency Nurses Association

           Opposition 
           
          None on file
           








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          Analysis Prepared by  :    Jill Rice / ED. / (916) 319-2087