At the end of 1991, the Colorado Medical Society published concussion research that they had been working on since the death of a high school student from second-impact syndrome. The paper outlined clear guidelines on the appropriate response to suspected concussions. The NCAA and high school teams almost immediately adopted the new, stricter guidelines on how to care for injured players.
The Colorado Medical Society guidelines were not the first published. In 1986, Robert Cantu of the American College of Sports Medicine published his own Concussion Grading Guidelines, which he would go on to update in 2001. The American Academy of Neurology also released their own guidelines.
All three were trying to establish return-to-play criteria for football players who had sustained head injuries.
Concussion guidelines establish a grading system to determine the severity of the injury. Grade 1: Confusion, no loss of consciousness; Grade 2: Confusion, post-traumatic amnesia, no loss of consciousness; Grade 3: Any loss of consciousness. The guidelines were very restrictive to injured players, recommending that anyone who had been unconscious for more than a minute should be kept from playing for six months.
High School Changes
Although the NFL did not act on the information or recommendations, the medical consensus pushed the NCAA football conferences and individual college teams’ sports medicine staffs to change their rules around what to do with players suspected of head injuries. These new rules were much more stringent, coming as they did from new information about the potential for permanent brain damage from any traumatic brain injury, including mild concussions.
Most lower-level football groups, high school, middle school, pee-wee, also changed their criteria to protect players. These changes would spread from football to the other sports very quickly.
The NFL, on the other hand, waited another three years before creating a committee to investigate the effects of concussions on players.