Head injury
 

Middle school tournament.

Player goes down clutching his head. Partner goes in to see what is wrong and spend several minutes with the player. She coaches him to sit up when he is ready. Contrary to what I have be taught to avoid player who has been injured.

I confirm with the table staff that there is no trainer on staff today. I ask my partner if she suspects a head injury. She confirmed I tells her that the player is then disqualified for the day as I suspect a head injury. She says that she agrees unless the tournament director says otherwise. I inform her that without medical clearance this child will not play again today, at least on my court. She informs me that she will listen to the tournament director. I inform her that the tournament directors can say what he wants but when the ball is tossed it is then our responsibility as the game officials.

Partner feels that there is no expectations for us a officials to know the prototypical. However, my argument is that as high school officials there is an expectation both legally and ethically to protect the players and in addition we have liability if we suspected a head injury to have the player medically cleared (in Arizona a staff trainer qualifies as the medical professional).

Looking for thoughts on this saturation and other ways to handle it.

FWIW both me and partner are high school varsity officials as certified by the state association

I like what you did, good job sticking to your principles.

The officials have all the authority here. That kid wouldn't play if I was officiating. If the TD felt otherwise, I'd leave.

My partner also disagreed with me and said that she will contact her mentor. I said that was fine but having high school officials is different from asking some guy in the gym to officiate a game. By using high school officials there is an expectation that we know the game and the rules. As her mentors are high level officials in Arizona I hope they agree with me but even if they don't I would stick to my guns and disallow this player from entry on my court I could not imagine allowing a middle school kid who may have a brain injury (as a concussion is) to play and risk further injury.

If you have no protocals for that level meaning there is no league or association procedures, then you have to protect yourself the best way you can.

We have a state law which means that someone that is an Approved Healthcare Professional has to review any player that has exhibited signs of a concussion, when identified by the officials. If there is no AHP around, we do not allow them to come into the game. And the schools have to have someone in place so that these situations can be reviewed. Otherwise this is not a situation we allow a player to continue.

I had this happen in an AAU game and we refused to allow the player play when they were clearly wobbly and someone out of the stands tried to verify their credentials. It was a tournament and no one associated with the tournament was an official medical person. I stood my ground and got a lot of crap about it, but I was protecting myself not just the player legally.

Peace

I'd do pretty much exactly what you did.

I don't see the connection on how your partner handled this and being a varsity official.

I cut out some of what you said, and mostly left it to show how poorly this was handled, unless I missed something.

Several MINUTES went by? How? Moment I blow my whistle because someone is hurt I'm yelling, "Coach." It's his/her responsibility to come over and deal with it. After that, it's gross negligence if you let them play without someone acceptable to clear them(If you think there is a head injury). No trainer to clear him? He's not playing.

You should feel like a hero for being there to handle this with some sort of decency.

I agree with you 100%. The reason I mentioned that we are both varsity officials is that the is an expectation for knowing the rules.

Coach's responsibility, not tounament director.

By rule.

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Please site your rule reference/

2-8-5 says officials duty to remove player with concussion symptoms. 2.8.5 play says officials need not verify that healthcare provider approved etc. it is school and coach responsibility.

i have no problem with what you did.

Regardless of what "rules" are in effect for various leagues, tournaments, etc., there are laws in all 50 states that govern concussion risk management for youth sports.

You did the right thing. When in doubt, sit them out.

Here's how we're told to deal with a suspected concussion.

1) Send her out, and tell the coach that she needs to get checked out.
2) She get evaluated by a AHP.
3) If the AHP clears her, she can be returned to the game.
4) We, as officials, don't need any kind of or information from the aforementioned AHP... if the coach lets her back in, we're to assume that she's been cleared by an AHP.
5) If the player shows any concussion symptoms again, GOTO step 1.

HOWEVER

If I know (or can reasonably assume, as in the OP's case) that there's no AHP around to provide clearance, I'm sending her back out basically as soon as she returns to the court, probably before I let the ball become live. "Coach, she's showing symptoms again, she needs to be re-evaluated." Repeat as necessary until the message has gotten across.

With that said, I have no problem with how you handled it.

Exactly....and they're probably different in every state.

Oregon...we send them to the bench. If it is a private school, they're done for the game. If it is a public school, the coach can send them back in. If we observe concussion like behavior, we can send them back out. But the onus is on the coach to manage the situation.

Yeah, I know, but that is how the law came out...there are parties trying to fix the differential treatment between public and private.

Cam,

I believe that they did fix the private/public school differences issue in the last legislative session.

In Michigan, MHSAA, has taken all responsibility away from the officials in regard to concussions. Here is an excerpt from a letter sent out about concussions.

1. The officials will have no role in determining concussion other than the obvious one where a player is either unconscious or apparently unconscious. Officials will merely point out to a coach that a player is apparently injured and advise that the player should be examined by a health care professional
for an exact determination of the extent of injury

4. Following the contest, an Officials Report shall be filed with a removed player’s school and the MHSAA if the situation was brought to the officials’ attention.


If a coach does not to have a player checked out and return her to the game, the official has no authority (through the MHSAA) to take action.

Looks like you are correct, if I am reading the reference I found correctly.....

https://www.oregonlegislature.gov/bi...5orLaw0392.pdf

Looks like a trainer or other defined healthcare professional can declare it to not be a concussion and the player can return for both public and private.

Kind of an oddly written law....so a healthcare professional, as defined in the statute, can release an athlete but no sooner than the day after the event. However, a licensed trainer can release the athlete on the same day, regardless of consultation or opinion from a healthcare professional. Why not just include licensed athletic trainers in the definition of healthcare professional and allow them to release the athlete at any time?

Are trainers generally independent and free from undue influence from emotionally invested parties like coaches? If not, this is a fairly toothless law.

In Arizona we are told that if we suspect a head injury that we need to have the player evaluated by an appropriate medical professional and that we are to ask prior to the game if there is such a person on site (ideally meet them but sometimes they are at another event on campus). In Arizona the trainer is the medical professional as per the state association

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As a Certified Athletic Trainer I'll chime in on this. First I would say that as a medical professional we should be able to conduct ourselves independently enough to ensure our medical decisions are not being influenced by our connection to a respective team. With that being said there are those out there that don't do that, just as there are officials out there that are biased for/against specific teams/coaches/players/etc. Again the majority out there act appropriately professional, you just hope you get to deal with those more often than the others.

With that being said ATCs have been given various levels of authority/responsibility when it comes to concussions. Much of it revolves around where the wording in a state law it goes from "suspected concussion" to "diagnosed concussion". In my state a player can be sent to me for a "suspected concussion/head injury", I can do an evaluation and say "No, this player does not have a concussion, they can return to play today." If I find they likely do have a concussion, they are not only done for the day, but they are done until cleared by a physician (and even can't be cleared by a physician same day).

If the laws and protocols didn't include athletic trainers and non-physicians in the "evaluation" process then essentially any time an official sent a kid out it would be essentially disqualification from participation for the remainder of the day and in some states permanently since wording includes "removed until evaluated by AHP". That's a lot of doctor's visits for kids based off of an official using an abundance of caution if other professionals can't handle the "evaluation" step.

I will say I have had this argument with officials who say "No, he has a concussion and can't return." I usually reply with "Thankfully my medical degree allows me to say your diagnosis of a concussion is wrong and he can return."

Even if your state protocol doesn't have you ask before a game, I would suggest it. It solves the problem immediately if it arises. You ask before the game if there is coverage by a medical professional, they say no, fine. That means if a potential head injury comes up, you indicate to the coach they are out until evaluated and by their own admission there is no one present to evaluate them, indicating that player is done for the day.

I don't think that is what it is saying.. If it IS deemed a concussion, they must wait a day before any clearance is valid. If it is deemed not a concussion, they can return the same day.

That certainly seems to be what it says. As I read it, the plain text of subsection 3 (Sec1.3.a) requires the coach to hold out a player if only one of two conditions exist: signs, symptoms, or behaviors OR a diagnosed concussion. Sec1.3.b then clearly states that, if a players is held out under Sec1.3.a, upon approval of the healthcare professional (HCP), the player may return the next day if no signs, symptoms, or behaviors are present. In this case, both HCP approval AND lack of signs are required.

The only exception is that provided under subsection 4 (Sec1.4), the blanket provision allowing a licensed athletic trainer to make a final and unchallenged determination/diagnosis and same day return. This makes no sense to me - a trainer can return a player the same day but a neurologist can't. Doesn't that seem backwards?

I think the protocol is that the trainer is the one that will be present, not the neurologist. If the immediate assessment is that it is not a concussion, the player can return. They'll never get to a neurologist before the game ends...but it allows for the trainer to consult with one if there is one available. However, once someone thinks it is a concussion (even the lessor trained trainer), it is treated as a concussion and the player must stay out for a minimum of time.

Where are you getting the minimum amount of time?

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No medical professional can clear a player to return same day when they have been determined to have suffered a concussion.

Appropriate medical professionals can evaluate a player and determine no concussion was suffered and thus return them to play that day. This could be an Athletic Trainer or Neurologist or other professional as specified.

Note: Even if concussion was not suspected, symptoms remaining precludes athlete from returning anyway.

I'll say again, the rules/laws are written to ensure that athlete's are removed and properly evaluated. Sometimes that means there is no concussion.

It isn't a rule, but a state law. It is mentioned in the statute I linked to above.


Oregon State Law:

(a) A coach may not allow a member of a school athletic team to participate in any athletic event or training on the same day that the member:
(A) Exhibits signs, symptoms or behaviors consistent with a concussion following an observed or suspected blow to the head or body; or
(B) Has been diagnosed with a concussion.
(b) A coach may allow a member of a school athletic team who is prohibited from participating in an athletic event or training, as described in paragraph (a) of this subsection, to participate in an athletic event or training no sooner than the day after the member experienced a blow to the head or body and only after the member:
(A) No longer exhibits signs, symptoms or behaviors consistent with a concussion; and
(B) Receives a medical release form from a health care professional.
(4) A coach may allow a member of a school athletic team to participate in any athletic event or training at any time after an athletic trainer registered by the Board of Athletic Trainers determines that the member has not suffered a concussion. The athletic trainer may, but is not required to, consult with a health care professional in making the determination that the member has not suffered a concussion.

this was a good story on concussions, not really related but shows how you should be careful and how there should be strict rules in place.


http://www.nytimes.com/2015/12/14/sp...ocol.html?_r=0