Sacred Hearts Academy freshman Kaitlyn Miranda sprinted for the rebound, battling for control of the basketball–until a sudden crash sent her head hitting the hardwood floor. What seemed like a minor fall turned out to be a concussion, adding to the multiple head injuries she has suffered as an athlete.
“We both got the ball, and (the other player) flew me to the ground, but I don’t remember much that happened later,” said Miranda, who experienced headaches as she navigated the post-concussion recovery process. A concussion is a mild traumatic brain injury caused by a blow or impact to the head, resulting in temporary changes to brain function.
While concussions remain a concern, the number of reported cases in Hawaii has steadied, largely due to the state’s efforts to improve concussion management, protocol and awareness.
Strengthening awareness and legislation
In 2010, Hawaii saw an increase in reported concussions, coinciding with the launch of an initiative to support concussion management called the Hawaii Concussion and Awareness Program (HCAMP). The organization works with Hawaii’s physically active community and medical community with evidence-based research education, support and resources to manage concussions.
“When we first started out, you could clearly see an increase in concussions,” said Director of HCAMP Nathan Murata. “It went up to 1,200 cases that year.”
In 2020, a concussion epidemiology study by “Sports Health” supported this, showing concussions by Hawaii high school athletes (ages 13-18 between 2011 and 2017) was significantly higher than previously reported.
“Once we started the implementation of intervention of cognitive testing and the law kicking in, we slowly started to see a decline of concussions,” Murata said, noting that the initial increase in reported concussions was due to the emergence of HCAMP and its efforts to encourage students to report their concussions and symptoms more consistently.
Recognizing the need for stronger concussion management, Hawaii lawmakers passed two key laws aimed at improving safety for student athletes in 2012. Act 197 required the Department of Education (DOE) and the Hawaii High School Athletic Association (HHSAA) to implement concussion education programs to ensure students, educators and parents had the appropriate information for concussion management. Later, Act 262 expanded these programs to include younger athletes, increasing awareness at an earlier age.
Beyond advocating for these legislative changes, HCAMP continues to play a vital role in concussion education, Murata said. The HCAMP website serves as a key resource and includes basic information about concussions, as well as downloadable guides for each sport’s gradual return-to-play protocol. The website also includes a feature called “HCAMP BrainSpace,” an online portal offering concussion education and resources.
Concussion management in schools
Hawaii’s state laws have paved the way for how concussions are to be managed in public and private schools today. Schools adhere to the Athletic Health Care Trainer’s (AHCT) Concussion Management Program. This program requires high school athletes to take baseline assessments before participating in their sports. In the event of a suspected concussion, post-injury test results are compared to these baselines and guide treatment.
If a student experiences a concussion, they must wait for medical clearance before an athletics trainer can implement the Return to Activity Plan (RAP) or the Return to Play Protocol (RTP).
Treating concussions at the Academy
Academy Athletic Director Ryan Hogue believes having clear state laws in regards to concussion management is the best for student athletes.
“It leaves out interpretation because having a laid out policy, which is the law, (does not leave) a lot of wiggle room,” Hogue said.
Hogue has observed that parents and student athletes often try to find ways to return to their sports as quickly as possible, especially before upcoming competitions. However, resuming physical activity without proper clearance can be detrimental to a student athlete’s recovery.
“A concussion can lead to Second Impact Syndrome (SIS), which is permanent brain damage for someone who is not fully recovered, and that’s not worth anything,” Hogue said.
Beyond the risk of SIS, mismanaging a concussion or returning to play a sport too soon can cause long-term effects to a student’s daily life.
According to Dr. Jennifer King, a pediatric sports expert from Kapiolani Medical Center for Women and Children and HCAMP medical consultant, these effects may include “difficulty with school, not being able to perform at the expected level, depression and anxiety, chronic headaches and not being able to return to physical activity.”
“The most effective treatment options for those with a concussion is to return to a normal schedule and to some level of non-contact physical activity as soon as possible,” she said.
The Academy ensures that all students—whether they sustain concussions from athletics or non-athletic school activities—receive appropriate learning accommodations. These may include extended deadlines for assignments or alternative assessment methods. HCAMP has developed accommodations specifically for students recovering from concussions, which are outlined in their fact sheet for educators.
For freshman Miranda, it took up to two weeks for her to recover from one of her concussions. She said she received strong support from the school.
“(Teachers) were just aware that I got a concussion, so they would check up on me,” said Miranda, adding that she was reminded to limit screen time and take breaks during class when needed. “Life in school, home and practice was kind of hard because I felt really tired and slow, which made me be less active and less aware.”
Dr. King emphasized the key factors in concussion recovery, stating, “In taking care of athletes, the five things to really pay attention to are sleep, nutrition, hydration, stress reduction and physical activity.”
To prevent concussions, the Academy has also implemented precautionary measures. Student athletes are encouraged to participate in preseason training and conditioning to reduce injury risks.
“Preseason conditioning and strength training programs make sure that (the athletes) are well conditioned, so that (they) can be as focused and strong as possible while participating in sports,” Hogue said.
Cultural shift in concussion awareness
These efforts reflect a broader shift in the way sports injuries, particularly concussions, are handled. Increased awareness and evolving safety protocols contrast sharply with past attitudes.
Hogue shares that, based on his experience as an athletic director and former athlete, concussions were rarely reported before the 2000s.
“If you talk to anyone who played during that time, they would probably tell you that they had concussions,” Hogue said. “But you were never taken out of the game, and you were expected to play through it.”
Today, athletics in Hawaii are safer, he said, with students encouraged to recognize and report symptoms.
“One thing we don’t want is student athletes hiding concussions,” Hogue said. “That could put them at risk for (SIS), which can lead to permanent damage.”
HCAMP’s efforts to improve concussion management and awareness has created a safer environment in youth athletics across the state. Similar initiatives across the country aim to improve concussion awareness and management. One of those is the REAP program, which stands for Remove/Reduce, Educate, Adjust/Accommodate and Pace. REAP has become the national model for concussion management.
‘Normalizing’ concussions
While both local and national initiatives to increase awareness and improved concussion management, experts emphasize the importance of continued education.
“The research on concussions is ever developing, and it’s important to stay abreast of what are the most recent recommendations for concussion management,” Dr. King said. “The more we can do to normalize and help in the recovery process, the less we will have to worry about potential long-term effects.”
For Miranda, learning more about concussions has helped her to become a more resilient and informed athlete.
“After my concussion, I didn’t get up to the level that I played at before, but I’m planning to build up to it,” Miranda said. “I hope to eventually pass the level that I was at by practicing more and listening to my coaches.”
However, not all athletes share the same recovery experience. Many in Hawaii and across the nation suffer from severe concussions that significantly impact their daily lives. While progress has been made in supporting recovery, continued concussion awareness and education remain essential to ensuring student athlete safety.
“Hawaii high school athletics has one of the best programs in the country, as far as educating the public on concussion risks and treatment,” Dr. King said. “However, I feel that we can always work to make it even better.”
Miranda agrees, emphasizing the importance of concussion awareness for student athletes.
“Concussion awareness and prevention is important, and a concussion needs to be taken seriously,” she said. “It can affect the athlete now and in the future.”Given the serious effects concussions can have, Dr. King stresses the need for students, parents, coaches and educators to stay informed about prevention and recovery. Hogue agrees and adds, “We need to be an advocate to help keep youth safe.”
