In Jefferson City and Columbia schools, most athletes in contact sports are given a test usually at the start of the season to determine what their "normal" is.
After a suspected concussion, the athletes are tested again to see where they stand.
ABC 17's Reeter had Stefanie West, the certified athletic trainer at Hickman High School in Columbia, run through the test with her.
The examination includes asking the the athlete if they have any symptoms of a concussion as well as testing memory and concentration.
In Jefferson City, school officials track data on concussion among athletes looking for trends to get a better idea of what to focus on.
While this protocol may not seem thorough, not all schools have it. Also, the concussion must be caught.
"Do you think there are ever times where maybe a students does have a concussion, but they don't catch it out there and they are allowed back in the game?" Reeter asked.
"All the time," said MSHSAA's Richards. "And I don't want to say that facetiously, you know lackadaisical, but that's why we are out here trying to do this education."
Therefore, education is key. After calling more than a dozen schools in Mid-Missouri, Reeter discovered many athletic trainers are not in-house on a daily basis, like at practices where most injuries can happen.
MSHSAA says only about 25 percent of its member schools have an athletic trainer. For some schools, it's just the coach on the field helping athletes after an injury.
That is why the association requires all coaches to go through an education program on concussions each year.
Some of the rules in sports are also changing.
In football, players cannot initiate contact with an opposing players whose helmet has come completely off. And if your helmet does come off, you have to stop. Officials have also been told, 'if you see it, call it.'
"When it does occur, it's got to be called and if it's a penalty, it needs to be penalized," said Harvey.
Another person helping to get the word out about concussions is Nicoli.
Although he quit football, he helps film for the team and also speaks to classes about his experience.
"It's not worth it, you only have one brain," said Nicoli. "You can't really replace it."
MSHSAA continues to review concussion protocols each year. While schools have to follow the association's guidelines to be a member, the protocols can be different.
Some schools have plans in place that go above and beyond the requirements, with athletic trainers and baseline testing. Others are not as advanced.
Numerous athletic directors told Reeter that many times it comes down to funding.
However, like with the legislation passed in 2011, state lawmakers can set requirements for schools.
Currently, there is no talk about concussion legislation for the upcoming session.
And while Missouri is keeping track of concussions reports statewide, not every state it. That is something experts are calling for on a national level.