AMA House of Delegates
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As a physician for a high school football team, David Welsh, MD, says he backs the AMA move to protect young athletes from playing with concussions. Photo by Ted Grudzinski / AMA

AMA meeting: Policy tackles head injuries in young athletes

The AMA says those suspected of having a concussion require a doctor's written approval before returning to the playing field.

By Damon Adams — Posted Nov. 22, 2010

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As a team doctor at Batesville High School in Indiana, David Welsh, MD, has watched hard hits on the football field send players to the sidelines with concussions.

"If you have an individual who can't remember what quarter it is, that's a concussion. If we suspect one, we take their helmet and sit them," said Dr. Welsh, a general surgeon in Batesville, southeast of Indianapolis.

He said more should be done to protect youths from the health effects of concussions, and he thinks the AMA has taken a positive step toward making that happen.

At the Interim Meeting, the House of Delegates adopted policy saying that young athletes suspected of having a concussion should have written approval by a physician before they can return to play or practice.

The policy calls for the AMA to promote the adoption of such a requirement for school and other organized youth sports. The AMA also will encourage educational efforts to improve the understanding of concussions among athletes, parents, coaches and trainers.

"Any movement forward [to protect against concussions] is positive," said Dr. Welsh, an alternate delegate for the Indiana State Medical Assn. "What I don't want to see is someone have a concussion that's missed, and the next one is the bad one."

Research on the prevalence and impact of concussions on athletes has created new awareness about the problem nationwide. The Center for Injury Research and Policy said 40% of high school athletes with concussions return to play too soon.

The National Football League and the National Collegiate Athletic Assn. have instituted policies to prevent players with concussions from returning during the same game. State legislatures have pursued measures requiring removal of athletes suspected of having concussions.

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William Rosenblatt, MD, cites his own experience in backing helmet policy for skiers and snowboarders. Photo by Ted Grudzinski / AMA

Medical organizations also have issued guidance. Most recently, the American Academy of Neurology in October published a position statement that athletes suspected of having a concussion should be removed from play until they are evaluated by a physician.

"Concussions account for nearly 10% of all high school athletic injuries," said AMA Board of Trustees Member Edward L. Langston, MD.

"Even mild brain injuries can be catastrophic or fatal. To protect the health and well-being of young athletes, it's vital that a physician evaluate them and give them a clean bill of health before they return to play."

Protecting winter athletes

In another effort to protect young athletes from head injuries, delegates adopted policy calling for the AMA to support legislation requiring the use of helmets by youths 17 and under while snow skiing and snowboarding. The policy encourages the use of helmets by adults in both activities.

The AMA will encourage physicians to educate patients about the importance of using helmets. It also favors the availability of rental helmets at commercial skiing and snowboarding areas.

New York plastic surgeon William Rosenblatt, MD, has worn a helmet while skiing since slipping on the slopes and hitting his head about 14 years ago. He supports the new AMA policy.

"It's crazy to ski or snowboard without a helmet," said Dr. Rosenblatt, a delegate for the Medical Society of the State of New York. "I can go back to work with a broken leg; I can't go back to work with a broken brain."

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ADDITIONAL INFORMATION

Meeting notes: Public health

Issue: The April 20 explosion of the Deepwater Horizon oil rig caused an estimated 4.9 million barrels of oil to leak into the Gulf of Mexico. The spill is expected to have short- and long-term health effects on the region, residents and those who aided in the clean-up.

Proposed action: The AMA should continue to monitor health effects and public activities related to the spill and report new information as it becomes available. The Council on Science and Public Health will provide a follow-up report in about 2½ years. [Adopted]

Issue: Cannabis has known medical benefits and is recommended by physicians for some symptoms, including nausea, pain, muscle spasms and glaucoma. Yet its status as a Schedule I controlled substance creates barriers to needed research to better understand its effects and potential treatments.

Proposed action: Urge federal agencies to rethink cannabis' status, cut research barriers and create options for well-controlled studies for medical use. [Adopted]

Issue: Gay, lesbian, bisexual and transgender youth are at a higher risk for harmful behaviors such as smoking, suicide and drug and alcohol abuse. Many physicians feel ill-prepared to discuss sexual orientation with young patients.

Proposed action: Work with the Accreditation Council for Graduate Medical Education and the American Osteopathic Assn. to recommend that primary care residency programs assess curricula for training on caring for younger GLBT patients. [Adopted]

Issue: Immigrants who are HIV-positive are restricted from settling permanently in the United States because of outdated health policies.

Proposed action: Have the AMA amend its list of communicable diseases considered of public health significance to remove HIV from the list. [Adopted]

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