Concussions in the National Football League and the NCAA get most of the attention, but the problem is just as big — if not bigger — at the high school level, where more than 1 million boys a year risk potentially brain-damaging concussions.
Alex Pierscionek, 19, wants to change that.
Pierscionek, now a college student, is the lead plaintiff in one of the first class-action lawsuits over concussions in high school football. For him, it's personal.
People tell him he ran a few more plays after a head-on collision during practice two years ago at his Illinois high school. They tell him he collapsed. They tell him he was airlifted off the field.
"I don't remember that," he told NBC News.
The lawsuit Pierscionek is leading, filed in state circuit court in Chicago, accuses the Illinois High School Association of a "systemic failure to manage concussions," which it calls a "battle for the health and lives" of high school football players. It seeks a range of policy changes, including preseason testing of athletes' brain function and requiring that medical personnel be on call for practices.
Physicians say teenagers are especially vulnerable to brain trauma, pointing to a study (PDF) published this month in the Journal of the American Medical Association — Pediatrics. It found that the concussion rate among high school players is 11 percent higher than it is for college players. And at both levels, 58 percent of concussions are suffered in practice.
"A trauma to the brain can disrupt that very fragile, already fragile foundation that is just starting to be formed," said Dr. Cynthia R. LaBella, medical director of the Institute for Sports Medicine at Children's Hospital of Chicago, whose previous research the lawsuit cites.
But the Illinois High School Association says it already has strong rules in place. It argues that the lawsuit would make football too expensive for some schools and that the rules should be made by school boards, not by the courts.
Since a new state law required it in 2011, the association has had a formal concussion management policy that includes concussion and head injury information in the agreements parent and guardians must sign before their children can play any sport, including football. It says any athlete removed from a game for a possible concussion or head injury can't return without a physician's clearance.
"What we've done is provided a concussion education for 27,000 coaches over the last year," Marty Hickman, the association's executive director, told NBC News. "What we've done is modify football practices. What we've done is study all of our rules in all of our sports."But the lawsuit says that's not enough. It also wants the association to create and pay for a formal medical monitoring program for athletes and systematic specialist training for team physicians.
"I just want to make it safer. I want people to be safe," Pierscionek said. "I know it's a violent sport, but you can take precautions."
A similar suit was filed in December 2013 in U.S. District Court in Mississippi, seeking not only many of the same protections for all high school football players in the country, but also insurance coverage for concussed players who require medical treatment but aren't adequately insured.
M. Alex Johnson of NBC News contributed to this report.