Concussion advocacy and legislation: a neurological surgeon's view from the epicenter

Traumatic brain injury is the leading cause of death and disability in the world for adolescents according to the World Health Organization. Sports-related concussion is a small but perhaps one of the most preventable causes of that morbidity. Legislation to protect student athletes is one of the ways in which we can advocate for safety in sports. This paper reviews the legislative history of the first concussion law passed to protect youth athletes: Washington State's Zackery Lystedt Law. This history is viewed from the point of view of one of the participants in the efforts to pass laws in all 50 states. The key provisions of the Zackery Lystedt Law include (1) education for parents, athletes, and coaches; (2) immediate removal from play during a game or practice, after a suspected concussion with no return to play until (3); (3) written clearance by a concussion expert for return to play; and (4) uniformity of rules for all schools who use public land. Last, the nature of this legislative process, which included attorneys, legislators, and physicians, demonstrated that effective collaboration of local, state, and national leaders can address a critical public health challenge such as concussion affecting student athletes.