Concussion Protocols Vary Wildly Depending on Who Is on the Sideline

Only about half of high schools have a written concussion management policy, and even among schools that do, there is alarming inconsistency: a study found 18 instances where an athletic director and a coach at the same school gave different answers about whether their school had a concussion protocol at all. When no athletic trainer is present, which is the case at roughly one-third of U.S. secondary schools, return-to-play decisions fall to coaches who have at most a brief online concussion training module and a strong incentive to get their best player back on the field. The consequences are severe and irreversible. An estimated 50% of concussions in high school sports go unreported, and up to 80% of people who sustain a concussion do not realize they have one. Without a trained AT to conduct a sideline assessment using standardized tools like the SCAT5, these athletes continue playing with an active brain injury. A second impact before the first concussion resolves can cause catastrophic brain swelling, permanent cognitive impairment, or death. Even without a second impact, mismanaged concussions lead to prolonged recovery, academic decline, depression, and in some cases, the end of an athletic career. The 2024 Bridge Statement from the NATA updated concussion management recommendations for the first time in a decade, but guidelines are meaningless without someone qualified to implement them. A concussion protocol document sitting in a filing cabinet does not protect athletes. What protects athletes is a certified athletic trainer on the sideline who can pull a player, administer a cognitive assessment, and enforce a graduated return-to-play process over days or weeks against pressure from coaches, parents, and the athletes themselves. This gap persists because concussion laws, which all 50 states and DC now have, typically require only that a symptomatic athlete be removed from play and cleared by a "licensed healthcare provider" before returning. They do not require that a qualified assessor be present at the event to identify the concussion in the first place. The laws address what happens after recognition but ignore the far more common failure point: the concussion that is never recognized because no one qualified was watching.