2023 -- H 5857

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LC002238

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

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A N   A C T

RELATING TO EDUCATION -- SCHOOL AND YOUTH PROGRAMS CONCUSSION ACT

     Introduced By: Representatives Baginski, Noret, Casimiro, and McNamara

     Date Introduced: March 01, 2023

     Referred To: House Education

     It is enacted by the General Assembly as follows:

     SECTION 1. Title 16 of the General Laws entitled "EDUCATION" is hereby amended by

adding thereto the following chapter:

CHAPTER 91.2

SCHOOL AND YOUTH PROGRAMS CONCUSSION ACT

     16-91.2-1. Definitions.

     For the purpose of this section, the following terms shall have the following meanings:

     (1) "Athletic trainer" means an athletic trainer licensed under chapter 60 of title 5, who is

working under the supervision of a physician.

     (2) "Coach" means any volunteer or employee of a school who is responsible for organizing

and supervising students to teach them or train them in the fundamental skills of an interscholastic

athletic activity. "Coach" refers to both head coaches and assistant coaches.

     (3) "Concussion" means a complex pathophysiological process affecting the brain caused

by a traumatic physical force or impact to the head or body, which may include temporary or

prolonged altered brain function resulting in physical, cognitive, or emotional symptoms or altered

sleep patterns and which may or may not involve a loss of consciousness.

     (4) "Game official" means a person who officiates at an interscholastic athletic activity,

such as a referee or umpire, including, but not limited to, persons enrolled or provided as game

officials by the Rhode Island Interscholastic League.

     (5) "Interscholastic athletic activity" means any organized school-sponsored or school-

sanctioned activity for students, generally outside of school instructional hours, under the direction

of a coach, athletic director, or band leader, including, but not limited to, baseball, basketball,

cheerleading, cross country track, fencing, field hockey, football, golf, gymnastics, ice hockey,

lacrosse, marching band, rugby, soccer, skating, softball, swimming and diving, tennis, track

(indoor and outdoor), ultimate Frisbee, volleyball, water polo, and wrestling. All interscholastic

athletics are deemed to be interscholastic activities.

     (6) "Licensed healthcare professional" means a person who has experience with concussion

management and who is a nurse licensed under chapter 34 or title 5, a psychologist licensed under

chapter 44 of title 5 and specializes in the practice of neuropsychology, a physical therapist licensed

under chapter 40 of title 5, an occupational therapist licensed under chapter 40.1 of title 5, a

physician assistant under chapter 54, of title 5, or an athletic trainer.

     (7) "Nurse" means a person who is employed by or volunteers at a school and is licensed

under chapter 34 of title 5, as a registered nurse, practical nurse, or advanced practice registered

nurse.

     (8) "Physician" means a physician licensed to practice medicine in all of its branches by

the board of medical licensure and discipline.

     (9) "Physician assistant" means a physician assistant licensed under chapter 54 of title 5;

     (10) "School" means any public or private elementary or secondary school, including a

charter school.

     (11) "Student" means an adolescent or child enrolled in a school.

     (12) "Youth sports programs" means any program organized for recreational and/or athletic

competition purposes by any school district or by any school participating in Rhode Island

interscholastic league competition, and whose participants are nineteen (19) years of age or

younger.

     16-91.2-2. School district guidelines to be developed and implemented.

     (a) The governing body of each public or charter school and the appropriate administrative

officer of a private school with students enrolled who participate in an interscholastic athletic

activity shall appoint or approve a concussion oversight team. Each concussion oversight team shall

establish a return-to-play protocol, based on peer-reviewed scientific evidence consistent with the

Centers for Disease Control and Prevention guidelines, for a student's return to interscholastic

athletics practice or competition following a force or impact believed to have caused a concussion.

     (b) Each concussion oversight team shall also establish a return-to-learn protocol, based on

peer-reviewed scientific evidence consistent with the Centers for Disease Control and Prevention

guidelines, for a student's return to the classroom after that student is believed to have experienced

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a concussion, whether or not the concussion took place while the student was participating in an

interscholastic athletic activity.

     (c) Each concussion oversight team shall include to the extent practicable at least one

physician. If a school employs an athletic trainer, the athletic trainer shall be a member of the school

concussion oversight team to the extent practicable. If a school employs a nurse, the nurse shall be

a member of the school concussion oversight team to the extent practicable. At a minimum, a school

shall appoint a person who is responsible for implementing and complying with the return-to-play

and return-to-learn protocols adopted by the concussion oversight team. At a minimum, a

concussion oversight team may be composed of only one person and this person need not be a

licensed healthcare professional; provided, however, the person shall not be a coach. A school may

appoint other licensed healthcare professionals to serve on the concussion oversight team.

     16-91.2-3. Student participation in interscholastic activity -- Concussion brochure.

     (a) A student shall not participate in an interscholastic athletic activity for a school year

until the student and the student's parent or guardian or another person with legal authority to make

medical decisions for the student have signed a form for that school year that acknowledges

receiving and reading written information that explains concussion prevention, symptoms,

treatment, and oversight and that includes guidelines for safely resuming participation in an athletic

activity following a concussion. The form shall be approved by the commissioner of elementary

and secondary education.

     (b) The commissioner shall develop, publish, and disseminate a brochure to educate the

parents and the general public on the effects of concussions in children and discuss how to look for

concussion warning signs in children, including, but not limited to, delays in the learning

development of children. The brochure shall be distributed free of charge by schools to any child

or the parent or guardian of a child who may have sustained a concussion, regardless of whether or

not the concussion occurred while the child was participating in an interscholastic athletic activity.

This brochure shall satisfy the written information required in subsection (a) of this section.

     (c) This section shall also apply to youth sports programs.

     16-91.2-4. Removal of student from practice or competition upon suspicion of

sustaining a concussion.

     (a) A student shall be removed from an interscholastic athletics practice or competition

immediately if one of the following persons believes the student might have sustained a concussion

during the practice or competition:

     (1) A coach;

     (2) A physician;

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     (3) A game official;

     (4) An athletic trainer;

     (5) The student's parent or guardian or another person with legal authority to make medical

decisions for the student;

     (6) The student; or

     (7) Any other person deemed appropriate under the school's return-to-play protocol.

     (b) This section shall also apply to youth sports programs.

     16-91.2-5. Requirements for return to practice or competition.

     (a) A student removed from an interscholastic athletics practice or competition under § 16-

91.2-4 shall not be permitted to practice or compete again following the force or impact believed

to have caused the concussion until:

     (1) The student has been evaluated, using established medical protocols based on peer-

reviewed scientific evidence consistent with Centers for Disease Control and Prevention guidelines,

by a treating physician (chosen by the student or the student's parent or guardian or another person

with legal authority to make medical decisions for the student), an athletic trainer, an advanced

practice registered nurse, or a physician assistant;

     (2) The student has successfully completed each requirement of the return-to-play protocol

established under this section necessary for the student to return to play or practice;

     (3) The student has successfully completed each requirement of the return-to-learn protocol

established under this section necessary for the student to return to learn;

     (4) The treating physician, the athletic trainer, or the physician assistant has provided a

written statement indicating that, in the physician's professional judgment, it is safe for the student

to return to play or practice and return to learn or the treating advanced practice registered nurse,

the athletic trainer or the physician assistant has provided a written statement indicating that it is

safe for the student to return to play or practice and return to learn; and

     (5) The student and the student's parent or guardian or another person with legal authority

to make medical decisions for the student:

     (i) Have acknowledged that the student has completed the requirements of the return-to-

play and return-to-learn protocols necessary for the student to return to play or practice;

     (ii) Have provided the treating physician's, athletic trainer's, advanced practice registered

nurse's, or physician assistant's written statement under subsection (a)(4) of this section to the

person responsible for compliance with the return-to-play and return-to-learn protocols under § 16-

91.2-2(c) and the person who has supervisory responsibilities under subsection (b) of this section;

and

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     (iii) Have signed a consent form indicating that the person signing:

     (A) Has been informed concerning and consents to the student participating in returning to

play or practice in accordance with the return-to-play and return-to-learn protocols;

     (B) Understands the risks associated with the student returning to play or practice and

returning to learn and will comply with any ongoing requirements in the return-to-play and return-

to-learn protocols; and

     (C) Consents to the disclosure to appropriate persons, consistent with the federal Health

Insurance Portability and Accountability Act of 1996 (Pub, L. 104-191), of the treating physician's,

athletic trainer's, physician assistant's, or advanced practice registered nurse's written statement

under subsection (a)(4) of this section and, if any, the return-to-play and return-to-learn

recommendations of the treating physician, the athletic trainer, the physician assistant, or the

advanced practice registered nurse, as the case may be.

     (b) A coach of an interscholastic athletics team may not authorize a student's return to play

or practice or return to learn. The district superintendent, or designee, in the case of a public

elementary or secondary school, the chief school administrator, or designee, in the case of a charter

school, or the appropriate administrative officer, or designee, in the case of a private school shall

supervise an athletic trainer or other person responsible for compliance with the return-to-play

protocol and shall supervise the person responsible for compliance with the return-to-learn

protocol. The person who has supervisory responsibilities under this subsection may not be a coach

of an interscholastic athletics team.

     16-91.2-6. Mandatory training for coaches and game officials.

     (a)(1) The Rhode Island interscholastic league shall approve, for coaches, game officials,

and non-licensed healthcare professionals, training courses that provide for not less than two (2)

hours of training in the subject matter of concussions, including evaluation, prevention, symptoms,

risks, and long-term effects. The league shall maintain an updated list of individuals and

organizations authorized by the league to provide the training.

     (2) The following persons shall take a training course in accordance with subsection (a)(4)

of this section from an authorized training provider at least once every two (2) years:

     (i) A coach of an interscholastic athletic activity;

     (ii) A nurse, licensed healthcare professional, or non-licensed healthcare professional who

serves as a member of a concussion oversight team either on a volunteer basis or in their capacity

as an employee, representative, or agent of a school; and

     (iii) A game official of an interscholastic athletic activity.

     (3) A physician who serves as a member of a concussion oversight team shall, to the

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greatest extent practicable, periodically take an appropriate continuing medical education course in

the subject matter of concussions.

     (4) For purposes of subsection (a)(2) of this section:

     (i) A coach, game official, or non-licensed healthcare professional, as the case may be,

shall take a course described in subsection (a)(1) of this section;

     (ii) An athletic trainer shall take a concussion-related continuing education course from an

athletic trainer continuing education sponsor approved by the commissioner;

     (iii) A nurse shall take a concussion-related continuing education course from a nurse

continuing education sponsor approved by the commissioner;

     (iv) A physical therapist shall take a concussion-related continuing education course from

a physical therapist continuing education sponsor approved by the commissioner;

     (v) A psychologist shall take a concussion-related continuing education course from a

psychologist continuing education sponsor approved by the commissioner;

     (vi) An occupational therapist shall take a concussion-related continuing education course

from an occupational therapist continuing education sponsor approved by the commissioner; and

     (vii) A physician assistant shall take a concussion-related continuing education course from

a physician assistant continuing education sponsor approved by the commissioner.

     (5) Each person described in subsection (a)(2) of this section shall submit proof of timely

completion of an approved course in compliance with subsection (a)(4) of this section to the district

superintendent, or designee, in the case of a public elementary or secondary school, the chief school

administrator, or designee, in the case of a charter school, or the appropriate administrative officer,

or designee, in the case of a private school.

     (6) A physician, licensed healthcare professional, or non-licensed healthcare professional

who is not in compliance with the training requirements under this subsection shall not serve on a

concussion oversight team in any capacity.

     (7) A person required under this subsection to take a training course in the subject of

concussions shall complete the training prior to serving on a concussion oversight team in any

capacity.

     (b) The governing body of each public or charter school and the appropriate administrative

officer of a private school with students enrolled who participate in an interscholastic athletic

activity shall develop a school-specific emergency action plan for interscholastic athletic activities

to address the serious injuries and acute medical conditions in which the condition of the student

may deteriorate rapidly. The plan shall include a delineation of roles, methods of communication,

available emergency equipment, and access to and a plan for emergency transport. This emergency

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action plan shall be:

     (1) In writing;

     (2) Reviewed by the concussion oversight team;

     (3) Approved by the district superintendent, or designee, in the case of a public elementary

or secondary school, the chief school administrator, or designee, in the case of a charter school, or

the appropriate administrative officer, or designee, in the case of a private school;

     (4) Distributed to all appropriate personnel;

     (5) Posted conspicuously at all venues utilized by the school; and

     (6) Reviewed annually by all athletic trainers, first responders, coaches, school nurses,

athletic directors, and volunteers for interscholastic athletic activities.

     16-91.2-7. All other youth sports programs.

     All other youth sports programs not specifically addressed by this chapter are encouraged

to follow the guidance set forth in this chapter for all program participants who are age nineteen

(19) and younger.

     16-91.2-8. Rules and regulations.

     The commissioner of education shall promulgate rules and regulations as necessary to

administer this chapter, including, but not limited to, rules governing the informal or formal

accommodation of a student who may have sustained a concussion during an interscholastic athletic

activity or practice.

     SECTION 2. Chapter 16-91 of the General Laws entitled "School and Youth Programs

Concussion Act" is hereby repealed in its entirety.

CHAPTER 16-91

School and Youth Programs Concussion Act

     16-91-1. Findings of fact.

     The general assembly hereby finds and declares: (1) Concussions are one of the most

commonly reported injuries in children and adolescents who participate in sports and recreational

activities. A concussion is caused by a blow or motion to the head or body that causes the brain to

move rapidly inside the skull. The risk of catastrophic injuries or death is significant when a

concussion or head injury is not properly evaluated and managed.

     (2) Concussions are a type of brain injury that can range from mild to severe and can disrupt

the way the brain normally works. Concussions can occur in any organized or unorganized sport

or recreational activity and can result from a fall or from players colliding with each other, the

ground, or with obstacles. Concussions occur with or without loss of consciousness, but the vast

majority occurs without loss of consciousness.

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     (3) Continuing to play with a concussion or symptoms of a head injury leaves the young

athlete especially vulnerable to greater injury and even death. The general assembly also recognizes

that, despite having generally recognized return-to-play standards for concussion and head injury,

some affected youth athletes are prematurely returned to play resulting in actual or potential

physical injury or death to youth athletes in the state of Rhode Island.

     (4) Concussions can occur in any sport or recreational activity, furthermore, symptoms of

concussions may manifest themselves after the injury during school hours and in the classroom

setting. All school nurses, coaches, parents, and athletes shall be advised of the signs and symptoms

of concussions as well as the protocol for treatment.

     16-91-2. Definitions.

     For the purpose of this section, the term “youth sports programs” means any program

organized for recreational and/or athletic competition purposes by any school district or by any

school participating in Rhode Island Interscholastic League Competition, and whose participants

are nineteen (19) years of age or younger.

     16-91-3. School district’s guidelines to be developed and implemented.

     (a) The department of education and the department of health shall work in concert with

the Rhode Island Interscholastic League to develop and promulgate guidelines to inform and

educate coaches, teachers, school nurses, youth athletes, and their parents and/or guardians of the

nature and risk of concussion and head injury, including continuing to play after concussion or head

injury. A concussion and head injury information sheet shall be signed and returned by the youth

athlete and the athlete’s parent and/or guardian prior to the youth athlete’s return to practice or

competition.

     (b) School districts are required to use training materials made available by the United

States Center for Disease Control and Prevention entitled “Heads Up: Concussion in the High

School Sports/Concussion in Youth Sports” and any updates or amendments thereto, or training

materials substantively and substantially similar thereto. The department of education shall post

training materials made available by the Center for Disease Control and Prevention and the Rhode

Island Interscholastic League on its website. All coaches and volunteers involved in a youth sport

or activity covered by this chapter must complete a training course and a refresher course annually

thereafter in concussions and traumatic brain injuries. All school nurses must complete a training

course and an annual refresher course in concussions and traumatic brain injuries. Teachers and

teachers’ aides are strongly encouraged to complete the training course in concussions and

traumatic brain injuries. Training may consist of videos, classes, and any other generally accepted

mode and medium of providing information.

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     (c) School districts are encouraged to have all student athletes perform baseline

neuropsychological testing, computerized or otherwise. Parents and/or guardians shall be provided

with information as to the risk of concussion and/or traumatic brain injuries prior to the start of

every sport season and they shall sign an acknowledgement as to their receipt of such information.

     (d) A youth athlete, who is suspected of sustaining a concussion or head injury in a practice

or game, shall be removed from competition at that time.

     (e) A youth athlete, who has been removed from play, may not return to play until the

athlete is evaluated by a licensed physician who may consult with an athletic trainer, all of whom

shall be trained in the evaluation and management of concussions. The athlete must receive written

clearance to return to play from that licensed physician.

     (f) All school districts are encouraged to have an athletic trainer, or similarly trained

person, at all recreational and athletic events addressed by this statute.

     16-91-4. All other youth sports program.

     All other youth sports programs not specifically addressed by this statute are encouraged

to follow the guidance set forth in this statute for all program participants who are age nineteen

(19) and younger.

     SECTION 3. This act shall take effect on July 1, 2024.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO EDUCATION -- SCHOOL AND YOUTH PROGRAMS CONCUSSION ACT

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     This act would modernize and update the prior chapter on this subject by requiring the

development of school district concussion guidelines, a brochure for the students and parents, the

procedures for removal and return of a student from or to practice or competition and mandatory

concussion training for coaches and game officials.

     This act would take effect on July 1, 2024.

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