Nearly a decade ago, lawmakers in Oregon and Washington state enacted the first laws on how to handle student-athlete concussions, in reaction to severe brain injuries on the football field. Since then, similar laws have swept the country.

By 2014, all 50 states and Washington, D.C., had passed youth concussion laws, focused on letting young athletes heal after a concussion. Most require that athletes be pulled from games or practice until they’re cleared by a health care professional. But important details differ state to state.

As our investigation with partners Pamplin Media Group and InvestigateWest found, those new laws created a paper trail of concussions. But the concussion incident reports mostly stay in school files. Few states compile the trove of information to help identify concussion risks and potentially fix them.

In some places, athletic associations have done more with the data. The Michigan High School Athletic Association requires member schools to report details about every concussion as it happens and publishes comprehensive data annually. A similar sports governing body in Texas has partnered with the Peter O’Donnell Jr. Brain Institute to create a database of student concussions. Large high schools in Texas are required to participate starting this fall. Public access will be limited, as the institute plans to share data only through periodic reports. Hawaii has tracked student concussion numbers statewide for more than a decade, but with limited public reporting.

Of note: No laws specifically address the long-term risk of repeated hits to the head, which currently is a major concern in contact sports, particularly football. We aggregated state laws to create an easy way for you to compare yours with others in a series of graphics.

And state laws just set a minimum standard. Sometimes individual districts go further. If you’d like to dig deeper, we built a customizable form that makes it easy to ask your school district key questions. Join our network and get it here.

When in doubt, sit them out

How soon is too soon to return to your sport after a brain injury? It depends on the severity of the injury, and some states are more aggressive than others.

Seventeen states make sure no young athletes go right back into a game by requiring a minimum time out, usually about a day, or imposing other restrictions, such as requiring that athletes follow a specific protocol of gradually intensifying exercise, sometimes over a certain period of days.

These restrictions can vary depending on whether a concussion is actually diagnosed or just suspected. Almost all states require clearance by a health care professional before an athlete can go back to a game or practice, but mandatory minimums for time out may mean that not even a doctor can approve an earlier return to play.

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It’s worth reading the fine print for your state, because the rules about who can clear an athlete to return to play vary widely. Some state laws require health care professionals to have a minimum level of training in concussions specifically in order to permit a student to return to his or her sport. The Policy Surveillance Program has created a highly detailed database of all state laws through mid-2017.  

Laws generally put the authority to clear athletes into the hands of trainers and doctors, in part to take it out of the hands of coaches, parents or the athletes themselves, all of whom might feel pressure to play down head injuries that might threaten the team, season or tangible things such as college scholarships.

Athletic trainers: Secret sauce?

Our partners InvestigateWest and Pamplin Media Group collected paperwork on concussion incidents from public high schools across Oregon. Together, we analyzed the documents and found that if a school has an athletic trainer, the rate of concussions reported at that school is about twice as high as at a school without a trainer.

There could be other factors at play, such as the size of the school, but experts in other parts of the country also say athletic trainers make a big difference in noticing, and reporting, more concussions. The only national survey of high school sports concussions, the National High School Sports-Related Injury Surveillance Study, won’t collect data from schools without an athletic trainer, because researchers say the trainers are crucial in getting reliable information.

No states require that schools employ trainers, but the legislatures of New Jersey and Hawaii cover the cost if a school chooses to hire one.

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Not just high school (and not just football)

Athletes in many sports, notably soccer, basketball, wrestling and cheerleading, suffer concussions. But football remains the sport with the most concussions by far.

At the top, the NFL has changed rules to try to reduce head injuries and settled a class-action lawsuit with players who claim permanent brain damage from repeated head injuries. NFL payments are expected to pass $1 billion. The NCAA also has been sued over accusations of flawed concussion protocol in college football.

But most football isn’t played by professionals or college students. It’s played by high school athletes and even younger kids across the country, for whom the danger of repeated hits to the head is just as real.

Most state laws on concussion protocol cover anyone under the age of 18 or 19. But three don’t go that far.

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Next up: Return-to-learn

The first round of youth concussion laws focused on getting kids healthy enough to return to sports. Just over a dozen states require that schools have a plan to help students ease back into schoolwork if they experience post-concussive symptoms such as difficulty with memory, organization or paying attention.

So-called “return-to-learn” plans could, for example, limit screen time, allow a student to rest during the school day or give extra time to complete assignments. Some states link the field with the classroom, stating that if a student is not well enough to fully participate in schoolwork, she or he is not well enough to go back to playing sports.

Mandating return-to-learn policies has been included in proposed federal legislation on youth concussions.

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Our Sources

Sources: National Conference of State Legislatures (legislation database and return-to-learn laws), The Policy Surveillance Program at Temple University’s Beasley School of Law, the National Athletic Trainers’ Association, the Korey Stringer Institute at the University of Connecticut, The Network for Public Health Law and the Indiana Department of Education

Emily Harris can be reached at eharris@revealnews.org, Sinduja Rangarajan can be reached at srangarajan@revealnews.org, and Casey Miner can be reached at casey.miner@gmail.com. Follow them on Twitter: @emilygharris, @cynduja and @reedminer.

Emily Harris is a senior reporter and producer for Reveal. She previously served as an NPR international correspondent, based first in Berlin and later in Jerusalem. Her 2016 series on Israelis and Palestinians changing their minds about some aspect of their conflict won the Overseas Press Club’s Lowell Thomas Award, and her 2014 coverage of Gaza was honored with an Overseas Press Club citation. She also was part of the NPR team that won a 2004 Peabody Award for coverage in Iraq. Harris lived in and reported from Russia during the upheaval of the 1990s. In the U.S., she covered a range of beats for NPR’s Washington desk and reported jointly for NPR and PBS’ “Now” with Bill Moyers. Harris helped start and host “Think Out Loud,” a daily public affairs talk show on Oregon Public Broadcasting. She worked to evaluate and share new financial models for journalism as editorial director of the Journalism Accelerator startup. She’s drafted a screenplay about relationships born in war and collects audio stories of awful and mind-changing moments in people’s lives. Harris is based in Portland, Oregon.

Sinduja Rangarajan

Sinduja Rangarajan is a data reporter at Reveal, focusing on academic collaborations around workplace issues. She is the organizer of Mind to Mind, a symposium that brings academics and journalists together to foster conversation and partnerships. She is a former Google News Lab fellow. She is based in Reveal's Emeryville, California, office.