1. Senator Troy Fraser
CAP 1E.12
Austin, TX 78711
Dear Senator Fraser,
My name is Meghan Counihan. I am a student nurse at The University of Mary-Hardin
Baylor in Bell County, Texas. While Texas legislation supports guidelines and policies that
address traumatic brain injury (TBI) football injuries in our schools, I would implore you to
refine and create stricter legislation ensuring our students safety and health before returning them
to their activities. Tex. Education Code Ann. § 38.151 (2011 HB 2038) is a great start to
addressing this issue, but I would like to present to you some ways to expand upon and
implement further measures so that uncertainty about the severity of a TBI injury can be
eradicated completely. Other states such as California, Idaho, and Indiana expand upon their laws
to develop specific plans and guidelines to be met in the event of this crisis. These standards are
supported by research by the CDC, Boston University, HeadCase (A Head Health Management
System), and articles published in both the The Journal of Law, Medicine & Ethics and The
American Journal of Public Health. The purpose of these standards is to ensure student, parent,
and school official health, safety, and education at the utmost level of competence. This will
ensure that the citizens of Bell County Texas receive the safe and competent care that they
indeed deserve.
I have developed a 5 step model for the identification of a TBI injury, for implementing
treatment, and for ensuring that proper milestones are met before, during, and after the injury:
• Step 1 is awareness of the program.
• Step 2 is awareness of TBI injury causes and effects, both short & long term.
• Step 3 is proper identification of the injury by medical personnel.
• Step 4 is proper treatment to include rehabilitation.
• Step 5 is properly reintroducing the athlete back into the playing environment.
This is in hopes that every student is healthy and safe before returning to play, and to ensure that
students, parents, and coaches do not unknowingly place the student at further risk. Creating a
more organized protocol and implementing a program such as the “Heads Up” program
developed by the Center for Disease Control (CDC) specifically designed for the welfare and
safely of the public are ways that I propose to improve our already established system.
In successful implementation of these steps, ensuring that Step 1 has been implemented is
vital. Step 1 (awareness of the program) would consist of flyers, brochures, posters in common
areas (i.e. locker rooms, gymnasiums, etc.), as well as memorandums for the coaches, students,
parents, trainers all to read with signature portions. Step 1 and Step 2 (awareness of the injury)
would complement one another. While the information for the program would be distributed, so

2. would the research articles and published medical journals on the injury. By doing so would
eliminate any possible ignorance or deliberate disregard.
Step 3 (Identification of the injury) is the most difficult portion of all, due to the nature of
TBI. It is an injury that is constantly and intensely being researched and reevaluated for
understanding of prevention, diagnosis, and rehabilitation. I implore you to consider the
implementation of the Head Case Impact Sensor, to measure and protect the margin of error that
exists when a healthcare professional measures the severity level of impact. This technology,
developed by The Heads Up Company, would be vital in avoiding near-miss cases of TBI or to
back up with data the diagnosis of a medical professional so that there is no uncertainty about the
students need for care. With the help of organized, professional response teams, this step is more
manageable.
The current state statute lays out step 4 (Rehabilitation after Injury) and Step 5
(Reintroducing the Athlete), in a very detailed and responsible manner.
With all due diligence and while being as responsible as possible, the athlete will be able
to return to his/her chosen sport. Failure to do so will be detrimental to that athlete both short and
long term. It is all of our responsibilities to ensure that the future health of these athletes will not
be derailed because of an injury that, while it may not be entirely preventable, can be managed
and rehabilitated to the highest level possible. Please contact me with any additional questions
you may have.
Respectfully Yours,
Meghan Counihan
Student Nurse
719-373-9743 or meghan.h.counihan@gmail.com

3. References
Harvey, H. (2013). Reducing Traumatic Brain Injuries in Youth Sports: Youth Sports Traumatic
Brain Injury State Laws, January 2009–December 2012. Am J Public Health American
Journal of Public Health, 7(103), 1249-1254. doi:http://0-dx.doi.org.umhblib.umhb.edu/
10.2105/AJPH.2012.301107
Harvey, H., Koller, D., & Lowrey, K. (2015). The Four Stages of Youth Sports TBI Policymaking:
Engagement, Enactment, Research, and Reform. The Journal of Law, Medicine &
Ethics, (Spring), 87-90. doi:http://0-dx.doi.org.umhblib.umhb.edu/10.1111/jlme.12225
Head Case - Complete Concussion Managements. (n.d.). Retrieved October 19, 2015, from
http://www.headcasecompany.com/concussion_info/stats_on_concussions_sports
HEADS UP to High School Sports. (2015, June 4). Retrieved October 19, 2015, from
http://www.cdc.gov/headsup/highschoolsports/
Traumatic Brain Injury Legislation. (2015, July 14). Retrieved October 19, 2015, from
http://www.ncsl.org/research/health/traumatic-brain-injury-legislation.aspx
What is CTE? (2009). Retrieved October 19, 2015, from
http://www.bu.edu/cte/about/what-is-cte/