Is there a Dr. in da house
 

After a game, a team's athletic trainer {grown adult} came up to my partner and I to ask us how we would throw the UIC from the previous night under the bus. Please respond to the following situation.

F2, while batting, is HBP over the left eyebrow. General swelling, no blood, diziness or headache. F2 is replaced. 20 minutes later, it is now time for legal re-entry after receiving approval from the team's certified medical expert. The trainer states that he is licensed by the state and that it is his responsibilty to make these decisions.

This person states that the umpire would not permit re-entry unless a Dr's handwritten note was presented to him, or something to that effect. He told the umpire about his "credentials" and had taken responsibility for the player's re-entry. He stated that he would not call balls and strikes for the umpire and that the umpire should not have overruled his decision.

He brought us copy of the 2008 FED rulebook and told us there was no such rule requirement. The trainer thought this issue was important enough to be addressed by rule for medical personnel. Not wanting to argue w/ the guy, I stated that the UIC was protecting himself, the best interest of the kid's general well-being. I told him the UIC has final authority to agree with him or not agree. He may have forfeited the game. When it was obvious that his needs were not being met, he turned to my partner and asked about reporting the incident.

New this year: If a player has been rendered apparently unconscious, he needs written authorization from a physician (MD/DO) to return that day. 10-2-3-k.

If it was a bad enough shot to take him out of the game, I would say he looked unconscious to me and require the authorization specified by the rule. Just because the trainer says he assumes responsibility doesn't mean he does. That might be for a court to decide, and one of the arguments would be that the umpire improperly relied on the advice of some schmuck and put a seriously injured player at risk of permanent injury or death. No thanks.

Although I'm not sure it's new, the UIC was right, if he (the UIC) thought the player was unconscious.

That's exactly how I'd respond to the trainer, and I'd tell him the coach knows how to report this.

FED 10-2-3k is the new section for 2008:

k. Prohibit a player who has been rendered apparently unconscious during a
game to resume playing that day without written authorization from a
physician (MD/DO).

Notice that the MD/DO has been added to define the "physician".

Another reason they should just use OBR.

Is it common to have a medical personnel for HS games where you are?

I've never seen one at that level except in football, where they have a physician and a trainer on the side lines.

If I had to guess, I'm guessing it was the kids daddy.

Am I missing something here? The kid was hit by a pitch and had to leave the game. If he was hit by a pitch, that would mean he would go to 1B and thus would have to be replaced by a pinch runner. So, how can he come back in 20 minutes later?

First, the pinch-runner would go to 1B, since the batter was unable to do so.
Second, he has a re-entry privilege under FED rules.

Bob

Only the umpire decides whether the player needs a written authorization from a doctor (MD/DO), but since the player wasn't rendered (apparently) unconscious, I don't really understand why the umpire wouldn't let him return to the game.

I disagree with ruling that way just to absolve myself of any potential liability.

This comment is ignorant. The FED rules are the most explicitly written and include safety measures because they were written to be used by children.

That said, I don't think the rule was applied correctly based on the description given by the OP unless the trainer is lying when he said that the batter wasn't unconscious or anything.

I agree, Rich. The question wasn't "what is the right ruling", but "how do you responde when someopne asks about a previous game." Since "we" (the OP) weren't there, I just give the rule and try not to make a judgment about what really happened.

For some reason, too many individuals think the umpires in the next game are the proper channel in which to lodge a complaint.

Obviously. I would've simply said, "I wasn't here. Is the kid OK?" and escaped if that didn't change the subject.

I would have said the same thing. The ATC would then have to take that up with the powers to be.

But, my 2 cents. We are umpires. At the end of the day, whether we are doctors, lawyers, teachers, etc, when we are on the field, WE ARE UMPIRES. WE ARE NOT DOCTORS, ATHLETIC TRAINERS, etc. If you have a Certified Athletic Trainer at the game, you need to let them make the decisions. Who am I to tell an ATC that the player who just got hit should not return to the game? That is not my call. That is his/her call. That is what they get paid for. Unless you see the athlete laying there unconscious and they have to do CPR or mouth to mouth breathing, there is no reason not to let them return. I think the umpire made the wrong call.

An athletic trainer is not an MD or DO. If the player was apparently unconscious, even for an instant, that player doesn't return without a PHYSICIAN'S WRITTEN authorization.

I agree with you that an Athletic Trainer is not an MD or DO. But, they do have to work under the direction of an MD or DO. So, trust me, they know what they are doing. Athletic Trainer's have to go through 4 years of college and then pass a National Board test. My point being, as an umpire, it is not my job to tell whether the player was unconscious, it is a medical professional. In this case, the medical professional is the Athletic Trainer. This is another case of an official thinking they are more important then they really are.

You fail to understand. It is a requirement that written authorization from a doctor (from what I've heard some states require this on letterhead) is required to allow a player to return when the player appeared to lose consciousness TO THE OFFICIAL. The medical trainer is irrelevant in this process and will continue to be until the NFHS recognizes that person in the rule, same as they recognize an MD or DO. They won't, because the standard of training is much higher for an MD and DO and there are more stringent licensing requirements.

Now, if the trainer is an MD or DO, then that person can write me up authorization taking responsibility and I'll allow the player to return.

This is another case of an official doing what is expected of him and, like it or not, I am the ultimate authority of whether someone returns to the game. The trainer can go pound sand if he doesn't like it.

Welcome to the board, BTW.

No its actually another case of someone spouting off, that has never been involved in a lawsuite.

I hope your insurance coverage is as large as your sympathy for the Trainer.
A good lawyer will make swisscheese out of your argument.

Mr. Umpire, "Are we to understand, that "YOU" as the head official for this athletic contest in question, knowingly allowed a previously seriously injured player return to the game, and was permanently crippled when he was again hit by another pitch, without a docters written approval?

Yes or NO?

I certainly hope you carry a lot of insurance!!!!!!!!!!!!!

I'm a basketball and football ref, not a baseball umpire, but I check things out over here from time to time. That said, the rule is written the same in basketball and baseball at the Fed level.

Being unconscious, per the rules, is the determination of the game official - not anyone else. If there is any hint of LOC, I'm calling the player unconscious. Your individual judgment may differ, but PLEASE do not think that someone needs airway support or CPR in order to be unconscious. In most cases where someone loses consciousness, they are still breathing on their own!

No way would I ever allow an athlete participate after an injury to the head. I have had head injuries and it's not worth the risk

You mean after an injury that rendered the athlete (apparently) unconscious, right?

Actually, according to the NFHS baseball rules, it is your job. If there is even the smallest of hints that the player has suffered LOC, he's done for the day until I get the proper written autorization.

Can we just get along?
 

Gratuitous name-calling leads to flame wars. It detracts from, rather than adds to, the value of the statement that follows. That a moderator then appears to agree with it is discouraging.

I do not fail to understand anything. I know the rule. The fact remains I am going to listen to the Athletic Trainer in this situation. I feel the way I feel. In my opinion, no medical professional, including an Athletic Trainer, is going to let an athlete back into a game that should not be playing. You guys do not give the Athletic Trainers enough respect. Most people think they are glorified EMTs. They are not. They are much more then that.

I am in agreement that if the athlete looses unconscious that an MD or DO will have to let the athlete back in the game. What we are arguing about is who makes the decision. I am not putting that burden on me.

Calling a comment ignorant is not name calling. I am referring to the comment, which I do find ignorant.

There's a difference between "this comment ..." and "you ..."

And, the comment did give me pause. Based on the rest of his body of work here, I gave the benefit of the doubt to Rich.

Of course! That is what we are chatting about. I respect Certified Trainers but the rules are pretty straight forward on who can make the authorization.

-Josh

No, it's just a case of following the rules. If the player was rendered (apparently) unconscious, the rules say the Athletic Trainer's opinion isn't good enough. The umpire isn't making that decision, someone else did. The umpire decides if the player was unconscious. The doctor decides if he returns.

Let's agree to disagree on this topic.

Agreed. AND IF a partner let a player, who had been knocked out, back into the game - without a note from an MD or DO - I do believe that this partner would be finishing the game alone. Trainers are great at what they are qualified to do, but they do not meet the requirements stated in the rules.

I will agree (with anyone else) that you are wrong.

That is the type of comment that does not have to be made. Grow up.

But, I do agree with Steve M, if a partner did let a player back into the game with those symptoms, they were wrong. The good thing is, the NFHS and most state associations are starting to allow Athletic Trainers to do more and more.

Man, I think you missed what I was saying - or at least meant to be clear on.
If you & are are doing a game, a player is knocked out, and you let him back into the game with only the OK of an athletic trainer - you will finish that game alone.
And I live in an area where it is very likely there are several docs in the stands - in this county, we have 1 doc for every 300 people. (That also means there are a lot of lawyers around too)

And I'm not asking a trainer his opinion on "apparently unconscious." By rule, that belongs to me.

Ok, but until it's in black and white that an Athletic Trainer can approve the return of a player who has been unconscious you can't allow their return. By doing so, you are asking for a court date.

Just my opinion (and others), but I believe you are wrong by allowing the player to return based on an AT's opinion. As I said, do as you wish, but you are asking to open a big can of worms.

Troll alert. Do not feed.

Let me ask this question. What if you deem the player was not unconscious and the Athletic Trainer said he was unconscious. Would you let the player return?

If anybody told me the player was unconscious I'm keeping him out until I get a doctor's note stating that he's okay to play. This is not a two-way street. Let's be clear, we're concerned about a concussion. If a player exhibits any of the following symptoms I'm not allowing him back into the game until he has his note.

• Appears dazed or stunned
• Is confused about assignment
• Forgets plays
• Is unsure of game, score, or opponent
• Moves clumsily
• Answers questions slowly
• Loses consciousness
• Shows behavior or personality changes
• Can't recall events prior to hit
• Can't recall events after hit

Or the athlete himself might report the following symptoms if he has a concussion, including a:

• Headache
• Nausea
• Balance problems or dizziness
• Double or fuzzy vision
• Sensitivity to light or noise
• Feeling sluggish
• Feeling foggy or groggy
• Concentration or memory problems
• Confusion

Other important facts about concussions include that they:

• are caused by a bump, blow, or jolt to the head
• can occur even if the athlete doesn't lose consciousness
• can happen in any sport
• may not cause symptoms until days or weeks after the injury
• can cause brain swelling, permanent brain damage, or even death, if an athlete has a second concussion before fulling recovering from a first one

I would have to evaluate the situation on an individual basis. No one-size-fits-all answer. Depending on the situation, and the trainer, I might allow his assessment to help form my decision.

There's no rule against that.

But there is a rule about allowing an player rendered unconcious to return the game without written authorization from a physician. So, if the AT convinces me that the player was unconcious, the player will need that note to get back in the game.

And if I am to err, I will err toward the side of caution. If the trainer is adamant that the player was knocked out, the kid is probably gone until complying with the rules for coming back.

The fact of the matter is I hope this hardly ever happens to anyone because it is one of those situations where you are damned if you do and damned if you don't.

If the AT said he was not fit for play, I'd take his word for it. In this case, he's an expert.

I don't think you grasp what we are saying here.

This is not about Athletic Trainers.
This is not about a player being uncounscious or not.
This is not being dammed.

This is about protecting yourself from being accused and convicted of negligence and the penalty (which may be financial or other).

I would not even take the advice of my own son on this subject and he is a certified Athletic Trainer. Unfortunately, until he graduates from Med. School the judge probably won't want his advise either.

Trust me, I agree with all of you and I do grasp what you are all saying. Being on forum and not in person, things could have been explained much better. I thank you all for your input. I consider this topic closed.

Neither an athletic trainer nor an EMT are the equivalent of an MD. BTW, if I'm
involved in a serious traffic accident, I'd rather have an EMT treat me than an athletic trainer, so the comment highlighted in bold makes no sense to me.

What a predicament
 

Welcome. Coach, administration, or police officials may understand how the UIC felt too. No one here saw the blow, nor the batter's reactions afterward. The UIC was w/in 6 feet away. Perhaps, it provided him with a more accurate assessment or it may have clouded his best judgment.

Perhaps F2 was an impt. link to victory and this ATC was "too-close" to the action. I think you felt strongly enough for the ATC that you have given him a proper voice. At my school, our ATC is "Doc" and "we" send kids w/ injuries to see him. This guy practically lives at the school and spends as much time there as the principals. He is the first line of response to any athletic injuries needing emergency treatment. I doubt I have ever seen an actual physician treat an injury during my time there. Perhaps this ATC was right, but what happens next, couldn't he just let it go? The ATC was still "ventilating" about it.

If anything, this event was an eye-opener into the type of responsibility placed on our shoulders. Thanks for the comments. Perhaps, those of us lacking experience with either the rule, or the "people" skills to handle something of this magnitude may take notice here. It boils down to possible LOC or not, and then seperate verdicts from 2 very reliable witnesses.

Have a great season.

This I would agree with. But it's not a 2 way street -- I would not allow the player back in without the written authorization from the doctor.

Horse beaten.

I totally disagree

This has nothing to do with an official thinking they are more important then the game. It is the case of an official KNOWING and FOLLOWING the rules.

Regardless of what you think the rules DO NOT say Athletic Trainer. They say from a physician (MD/DO).

This is an amateur baseball game and the team "can live' without this player for the remainder of the game.

Remember it's a GAME

Pete Booth

How would you guys handle the situation? Personally I would tell the coach when he gives me his replacement right after the injury so both the coach and the ATC know that he is not coming back unless there is a note from an MD. From the original post it sounded as if the umpire stayed silent on the situation, thus creating the confusion.

In Ontario we do have a similar procedure in place, however it is enforced by the school staff as it calls for the athlete not to participate in any activity until cleared. Activity means practice and/or game and the athlete sits out until cleared not just for the day.

An AT is NOT an MD/OD. Give me the official letterhead from an MD that says the kid can play.

I know I'm late into the discussion, but I agree with the general concept that the rule should be followed to the letter. Loss of consciousness = signed release from MD/DO.

What I don't agree with, however, is some the posters that have implied that any signs, symptoms, or similarities to a head injury require a doctor's release. I understand the concept of better safe than sorry, but just because a kid takes a pitch to the head and takes a second to get up doesn't mean he was unconscious. Just because a kid takes a pitch has a knot on his forehead, doesn't mean there is a loss of consciousness. I'm sorry, but for all the preaching about following the letter of the law, there seem to be alot of posters that want to declare a kid unconscious just to be safe rather than because he was actually unconscious. This is just my interpretation of what others are saying. If we are going to play the better safe than sorry angle then shouldn't we be requiring full neuroloical work-ups including EEG, CT scans, etc? The purpose of the rule is to protect the kids, not the umpires.

Who are you to say that the player can't play if they exhibit signs of a concussion. We can only limit return to play in the event of an apparent LOC not a concussion.

This discussion is very trying for me because I am both and umpire and an Athletic Trainer. The rule clearly states that in the event of apparent LOC then the player must have written permission/clearance from a MD. Let me tell you something, any ATC worth anything, and that has any clue, will not allow a player to RTP if there is any thought that there was LOC. Any time I have apparent LOC with my athletes, their in the ER asap.

I think that umpires need to be aware of LOC. Reading this I'm not sure that you guys know the difference between a concussion and LOC. Dazed/Confused/Dizzy/Amnesia, all that from the list above does not equal a loss of consciousness.

I think that, and the way that I would handle this situation if there is no ATC present, is after everything calms down, as the coach and I are discussing who the replacement is, I would tell the coach that in my opinion that player had a LOC and state why that is (unresponsive, blacked out, etc). If he asks me why I feel that way, then i explain my medical experience. I truely believe that if this happens, 1. the coach doesn't try to put the kid in, and 2. he won't have a problem with me saying hey I feel this way and this is what i observed. I don't think that he needs to be told that the player cannot return unless a doc's note is present, becasue he's going to seek one out maybe. Also, it needs to be noted on the line-up cards that there was LOC and why. And if the coaches have a problem, all you have to tell them is Tough crap, let move on

Eagle_12, the chart waltjp copied was provided by the "Department of Health and Human Services Centers for Disease Control and Prevention," or as you might say, DOHAHSCFDCAP, so if you have a problem with it, maybe you should take it out on them. But they probably don't know what they are talking about because they are not Athletic Trainers.

Their first recommendation in the Point of Emphasis was to "Remove athlete from play" if you SUSPECT, that a player has a concussion.

Being, just a "dumb ole umpire" and not an expert Athletic Trainer and also following the rules, I will not let a player return without a physicians written authorization if they exhibit the Signs and Symptons suggest by the Department of Health.

Finally, I really don't believe that you need to explain to a coach that because his player is "unresponsive or blacked out" that they had a loss of consciousness, and that you determined that because of your medical experience. DAH.

But being just a dumb ole umpire, who am I to say.

Please show me where it says that we can limit due to a concussion, let alone a "suspected" concussion.

different sport (Softball) FED rules...... Batter takes a pitch of the helmet..happens a lot..no big deal, right? well instead of going to first, she just stands there....shakes her head....and shakes it again.... I talk to her, and she doesnt respond... I tell her to look at me, and she finally looks in my direction and her eyes are unfocused.....I figured it was a concussion then, and NO WAY IN HELL was she going to continue that game. Report me, whatever. The trainer then comes up and tells me its her 3rd ONE SINCE THE start of the school year! 2 in BASKETBALL, and now this one. I told the trainer and head coach that tehre was no way she was continuing, and in my unexpert opinon, she shouldnt be playing any sports for a LONG time! (ever?)
I wrote a letter to the state association..never heard anything back..my point is...Im going to err on the side of caution...fed game, concussion= trip to the doctor, and doctors note. Period.

I'm not a health care professional...and, frankly, I haven't read all the posts in this thread: I'm too tired and its too late.

However, I will add, that as an attorney, I advise all my umpire friends:

If they themselves have first-hand knowledge that a player became "apparently unconscious" OR they are told from a reliable source (i.e. a trainer, coach, etc.) that the player was unconscious...there is no friggin' way that player is coming back in the game unless I receive a note (in triplicate :D ) signed by a MEDICAL DOCTOR (MD). Period, end of discussion.

This thread has gone on too long.

A. I let a player with a suspected concussion return to play

1. He may not be reinjured
2. He may be reinjured due to his decreased ability to play

a. I may not be sued.
b. I may be sued.

1. I may win the lawsuit.
2. I may be found negligent.

a. I may not lose all I own
b. I might lose my house, my car, any savings I have etc.

B. I do not allow him to play

1. The coach will agree he should not play
2. The coach and the parents will think I am an OOO.

I can live with option B.

Coach: "I'm bringing Johnson back in to catch. Number 4."
Umpire: "Isn't he the one who was hit in the head?"
Coach: "Yeah, our trainer checked him out. He's fine"
Umpire: "I'm not letting him in. He was hit in the head and he should sit."
Trainer: "I checked him out. I followed our shool's protocol for head injuries. I watched while he did some sit-ups and deep knee bends. It is my opinion that he is fit to play."
Umpire: "I need a note from a doctor. Until then, he sits."
Coach: "Are you saying that he was unconscious?"
Umpire: "No, I am saying that because he was hit in the head he could have a concussion, and I need a note to allow him to re-enter."
Coach: "I protest your application of 10-2-3k."

If IMO there was any chance the player suffered a concussion I can live with that and will have the full backing of our association.

I just happen to have a significant amount of training & experience (EMT, mountain rescue) and can rather easily determine the risk factors present in allowing the player to return.

My suggestion to any game official is this: weigh the risk - if you feel the player was suffered sufficient head injury that you are not comfortable with his/her return keep them out. No HS game is worth a child's future.

My suggestion to any game official is this: weigh the risk - if you feel the player was suffered sufficient head injury that you are not comfortable with his/her return keep them out. No HS game is worth a child's future.[/QUOTE]

Amen

He appeared to momentarily lose consciousness. Play ball.

Protest that.

The key to my post was not in that the coach can protest. The key is that the trainer followed a protocol.

The Fed provides guidelines for institutions to use in setting up protocols for dealing with head injuries. This document is found at the NFHS web site under Sports > Sports Medicine > Information on Concussions.

This document also discusses what coaches and administrators can look for if they are without a trainer or other "trained and knowledgeable" individuals at their games or practices, they being in a position to compare the athlete's normal behavior against how this person is behaving post injury.

I believe NFHS would like to see a more rigorous set of criteria placed on how to deal with returning players to action after suffering a potential head injury, but the only mandate that is written is found in 10-2-3k.

Basically, NFHS is leaving it up to the schools to decide how to deal with these situations, but in extreme cases where a player is attempting to return after losing consciousness, they have asked the umpires to prevent re-entry.

Umpires are not being asked to enforce the guidelines as suggested to the schools, or even the guidelines that the CDC may suggest. My point is only to show that the bar for when we can step in is limited.

Duly noted, play ball.