The Maryland State Board of Education, on Tuesday, added new protections for student athletes, adopting emergency regulations requiring training for coaches in the area of brain injuries. "These emergency regulations have already been in place for a year, but they make it a little bit stronger, and make them part of the regulations regarding athletics in the school," said Ned Sparks, Director of the Maryland Public Secondary Schools Athletic Association. "They have a shelf life of 180 days," continued Sparks. During that time, State Board members plan to work with healthcare and athletics experts to draft permanent regulations regarding brain injuries. Those regulations will go through the typical process, allowing for public input before being made final.

By August 31, each local school system shall train each coach in concussion risk and management, including criteria for removal and return to play and recognition of concussion symptoms. In addition, each school system is required to implement policies that assure athletes and their parents or guardians receive information about the nature and risk of brain injuries.

The emergency regulations also require a medical assessment if any student athlete is suspected of sustaining a concussion or other brain injury. The athlete will not be allowed to return to the contest until cleared by a licensed health care provider authorized to provide sports physical examinations.

Traumatic brain injuries in sports have been in the public spotlight, given attention at both the professional and collegiate sports, and State Board members wanted a regulation in place for the start of the 2012-13 school year.

According to the Centers for Disease Control and Prevention, between 2001--2009, an estimated 2,651,581 children aged ≤19 years were treated annually for sports and recreation--related injuries. Approximately 6.5%, or 173,285 of these injuries, were traumatic brain injuries. Approximately 71.0% of all sports and recreation--related TBI emergency department visits were among males; 70.5% were among persons aged 10--19 years. An estimated 2.5% of children and adolescents with sports and recreation--related injuries were hospitalized or transferred to other facilities, compared with an estimated 6.6% of those with sports and recreation--related TBIs. From 2001 to 2009, the estimated number of sports and recreation--related TBI visits to emergency departments increased 62%, from 153,375 to 248,418, and the estimated rate of TBI visits increased 57%, from 190 per 100,000 population to 298. During this same period, the estimated number of emergency department visits for TBIs that resulted in hospitalization ranged from 9,300 to 14,000 annually but did not show a significant trend over time.

Overall, the activities associated with the greatest estimated number of TBI-related ED visits were bicycling, football, playground activities, basketball, and soccer. Activities for which TBI accounted for >10% of the injury ED visits for that activity included horseback riding (15.3%), ice skating (11.4%), golfing (11.0%), all-terrain vehicle riding (10.6%), and tobogganing/sledding (10.2%).

Activities associated with the greatest estimated number of sports and recreation--related TBI ED visits varied by age group and sex . For males and females aged ≤9 years, TBIs most commonly occurred during playground activities or when bicycling. For persons aged 10--19 years, males sustained TBIs most often while playing football or bicycling, whereas females sustained TBIs most often while playing soccer or basketball, or while bicycling.