Heightened public awareness sparks new initiatives to recognize and react to brain trauma and other serious injuries.

Less than two weeks into the new decade, representatives from 30 medical and sports organizations (including the National Athletic Trainers' Association, the National Center for Sports Safety and the American Academy of Pediatrics) gathered in Sacramento, Calif., to raise awareness about catastrophic injuries in high school athletics. Billed as the "Summit on the Youth Sports Safety Crisis in America," the half-day event focused on concussions, exertional heat illness and sudden cardiac arrest, drawing certified athletic trainers, as well as members of the media.

A few weeks earlier, an estimated 200 parents, coaches and students attended a free public forum on brain injuries at a middle school in Wayland, Mass.

The summit in Sacramento and the forum in Wayland came on the heels of the National Football League's recent congressional hearings on concussions, some high-profile heart-related deaths of both amateur and professional athletes, and criminal charges against a Kentucky high school football coach (who was acquitted last year) in a player's heat-related fatality. Heightened public anxiety regarding sports-related catastrophic injuries, it seems, is finally leading to change.

The NATA (which organized January's sports safety summit) and other summit participants are emphasizing a newly drafted seven-point "call to action," which urges high school athletic directors, coaches, teachers, parents, athletic trainers and players themselves to do the following:

1.) Ensure that young athletes have access to healthcare professionals who are qualified to make medical assessments and decisions. According to the NATA, only 42 percent of all high schools in the United States currently have access to athletic training services. 2.) Understand the symptoms of musculoskeletal and neurological injuries. 3.) Ensure effective pre-participation exams. "The physicals that are adopted by schools and school districts don't necessarily ask the proper questions," says Michael West, president of the California Athletic Trainers' Association and an assistant principal/athletic trainer at Patriot High School in Riverside, Calif. "It all depends on how seriously each school or school district takes those exams. But documents containing the proper questions are out there. That's why we're trying to bring this to the attention of schools." West recommends guidelines set forth in the latest edition of Preparticipation Physical Evaluation, published by McGraw-Hill and six leading medical organizations. (A fourth edition will be published later this year.) 4.) Ensure that sports equipment and playing surfaces are checked for safety and best conditions prior to activity. 5.) Encourage state lawmakers to introduce legislation that would make high school sports participation safer. 6.) Support additional research of youth sports injuries and their effects. 7.) Eliminate the culture of playing through pain without assessment. "There has to be a fundamental understanding that there is a difference between being hurt and being injured," West says. "If you're hiding symptoms, that's when catastrophic injuries can take place - particularly heat illness and concussions."

Even though football receives much of the attention surrounding catastrophic high school sports injuries, research shows that male and female basketball, ice hockey and soccer players are especially susceptible to concussions. And last year, the American Journal of Sports Medicine reported that female athletes suffer more severe symptoms from multiple concussions than do their male counterparts.

In addition to raising public awareness, the Summit on the Youth Sports Safety Crisis in America sought to promote new legislation aimed at improving medical care for young athletes. Its efforts were echoed during Super Bowl week in early February with the announcement of a national initiative to reduce sports-related concussions in every state. The principles of that effort were established by Washington's Zackery Lystedt Law, which was passed last May and requires young athletes suspected of having sustained a concussion to receive medical clearance before returning to play.

Spearheaded by the Sarah Jane Brain Foundation in partnership with the American College of Sports Medicine, the Zackery Lystedt Brain Project's goal is to increase public awareness, training and legislation while encouraging further research. Last year, Oregon passed a measure similar to the Lystedt Law, and legislation is pending in several other states, including California, Florida, Massachusetts, New Jersey, New York, Pennsylvania and Virginia.

"We are going to get maybe 24 states passing the laws or making serious headway this year," SJBF founder Patrick Donohue recently told The New York Times. The national foundation dedicated to youth brain trauma is named after Donohue's young daughter, who was seriously injured after a nurse violently shook her as an infant. "Washington's law is a work of art, and it took almost two years. But they've already done the hard work. We don't need to take two years in every state."

West hopes that, at least in California, Gov. Arnold Schwarzenegger's signature will grace a version of the Lystedt Law by August or September. Two sweeping pieces of state legislation, both introduced in January by Democratic Assemblymember Mary Hayashi, would require medical clearance before student-athletes who have suffered a sports injury can return to play, expand coaches' first aid and CPR requirements by the end of 2011 to include specific education regarding recognition of and reaction to catastrophic injuries, mandate automated external defibrillators at all high school games and practices by July 2014 and require the adoption of a statewide heat acclimatization program. Early support for the bills appears to be strong.

"Coaches are put in situations where they have to make decisions, whether there's a certified athletic trainer on site or not," says West, whose organization is sponsoring some of California's proposed legislation. "They have to make medical choices when they don't necessarily have a high level of training. So we have to at least give them the tools to make the right decision."