Diabetic Seizure, Return to game?

[firedoc]

Here is an opinion from someone who is both a referee and a physician (Emergency medicine):
Don't let him/her play without a written note from a physician. By definition anyone having a true seizure, whether diabetic or other, is unconscious. In the post they said that he didn't respond to the coach. That is also a definition of unconsciousness.
Remember! Always err on the side of safety.

[RecRef]

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1. This is organized 5th Grade. They have various levels...some are "athletic" and some are more to just get the kids involved.
2. I am not a parent reffing. ?!?
3. I am Ohio Class 2 Certified.
4. The assignor for this league does not require certified officials if that matters, but I was assigned to work this and 2 other games.

Larks


[/B][/QUOTE]


Ok, the reason I asked and where I am coming from. - I am a member of the BOD of a rec league in Virginia. I run the boys side of the league and am also the scheduler for all games and practices. We put on 78 house games a weekend, not counting games for our 13-county/select/travel teams.

We employ refs from age 13 to us old guys. HS certified and not, even have had few DIII and DI parents/refs doing our games when they had the time. We operate under modified NF rules.

When we train our refs, or first take on certified refs we make it VERY clear that the safety of the kids is paramount over any and all rules. It is only at the high school level that we approach NF style of play.

I asked about your qualifications and if you were certified to ascertain your level of involvement. We have found that non-parent refs that have formal training/certification sometimes follow NF rules too closely.

Given your certification I would say that you did the correct thing, by rule, if it would have been a scholastic game. Schools have to take responsibility for their actions. Being that it was rec, I would have not allowed the child in the game. If he had the seizure while he was on the court would you have let him back? (Said to say Rec leagues generally do not take responsibility)

I would like to get Mark Padgett’s view on this.

[Mark Padgett]

Being diabetic, perhaps I can add to this discussion. It seems apparent this kid is "Type I" and experiences periodic bouts with low blood sugar. This is not that unusual in his case. FYI - the NBA's Chris Dudley suffers from the same condition and is able to recover quickly from these bouts enough to continue in pro games.

Personally, this could turn into a real legal problem. IANAL, but there is the point of you not letting the kid participate due to his "disability" when he apparently has his parent's permission to do so. Plus, he is not a danger to anyone else on the court. On the other side, there is a precedent in the rules for prohibiting further play by players who experience certain symptoms during a game such as falling unconscious for any reason.

I really don't have a definitive answer. At the HS level, a ruling from your state association might be in order. At the rec level, you should always have an agreement with the venue as to who makes these decisions and who takes the responsibility.

I cannot speak specifically as to what the kid was going through, since I am Type II and that is somewhat different.

[Mark Dexter]

Originally posted by Mark Padgett
Personally, this could turn into a real legal problem. IANAL, but there is the point of you not letting the kid participate due to his "disability" when he apparently has his parent's permission to do so.

It's true the kid might have an ADA issue, but that is best to let the legal profession sort out. He can always come in the next game when a ruling has been made. If he's back in this game, and gets injured, there might not be another game.

[Mark Dexter]

Originally posted by firedoc
Here is an opinion from someone who is both a referee and a physician (Emergency medicine):

Hey, firedoc, have you had any conflicts with being an MD and a ref?

[Kelvin green]

ADA allows for reasonable accomodations. I am not an expert in ADA by any means but it seems that the league has accomodated him by allowing to play. If I remember right at least in the employment arena, when there is a saftey issue
emplyers can limit the jobs a person with a seizure might have, and if the safety of an individual or the public would be great they dont have to make any sort of accomodation. I doubt we would have to here.

Personally I would be inclined not to let the kid play. I am not sure that it would be reasonable to let him play. If the kid has a second seizure or further injures himself and someone is sued there are a whole ton of people who will guess and second guess to determine if the actions were reasonable or not and we will be in the middle of that court, and it wont be as referees..

[Doug]

Safty precedents in my games, I would think that the player would need some form of a doctor's note in order to participate, at least in any game I would officiate. I have liability insurance also, i think it is around 3 million, but I hope I never have to use it. So, I would be on the safe side and not let the player participate, UNLESS, I had a note from someone in the medical profession stating that the player can play after a situation like this, and appears to be fine. Then, I would let them play, but my motto is always "it is better to be safe then sorry" this is a very controversial topic, it could bring some good disputes on the forum, but it's not like we've never seen that before

[Oz Referee]

As an aside, can I say that it is great to live in Australia, where out litigation laws are much tighter, and I therfor don't have to worry about been sued. (at least not to the extent of my American counterparts).

Having said that, I would have let the kid play, based on what I have heard here. Here's my reasoning:

1. He was not unconscious (by my definition, you can't be unconscious and sitting upright)

2. He had parental permission (legally might not mean much, but would still influence my decision)

3. He was not a danger to anyone else.

4. His condition (being diabetic) is a managable one, and as such, I don't feel that the player should be "punished" by being excluded.

5. I would assume (yes I know the ramifications of making assumptions) that the player (and hopefully his parents) would know more about his condition, recovery times, etc than me. If they both feel that he is ok to continue, and he is showing to obvious signs that I can observe - let him play.


But as I said, I usually don't need to worry about being sued....

[daves]

Originally posted by Mark Dexter

That's true, but officials only need to determine that a player is "apparently unconscious." Since few of us are medical professionals, unconscious can be broadly interpreted, if you get my drift .

BTW, daves, as an ER RN, do you ever get involved when a player has a serious injury and there are no EMTs on site?

I have fortunately never witnessed a serious injury or illness while officiating. I have on many occasions seen the sprained ankles and various other bumps and bruises. In situations such as that I rarely intervene as a health care professional, except to instruct someone to get ice or something of that nature. The only time I would lay a hand on a player is in the case of cardiac or respiratory arrest, a head or neck injury or if there was uncontrollable bleeding. I have on occasion had asthmatic player have problems during the game. If I see it, I will immediately blow the whistle and stop the game. I will send the player to the bench to get treatment.

[daves]

Originally posted by firedoc
Here is an opinion from someone who is both a referee and a physician (Emergency medicine):
Don't let him/her play without a written note from a physician. By definition anyone having a true seizure, whether diabetic or other, is unconscious. In the post they said that he didn't respond to the coach. That is also a definition of unconsciousness.
Remember! Always err on the side of safety.

Have you ever witnessed a serious injury or illness in a game that required your intervention as an MD? Would you as a qualified physician be comfortable in authorizing a player to return in a game that you are officiating? I think as an MD and an official it would open a can of worms in terms of liability if you did allow a player to return. If a player was unconscious(and you would know) I think you would have to err on the side of safety, as you say, and get that player off the the ER for evaluation.

[Mark T. DeNucci, Sr.]

This play does not fall under the Referee's elastic clause nor does this fall under the unconcious player rule. The only possible way that that a diabetic siezure might fall under the unconcious player rule is if the player was in the game at the time. But the play that you described in your posting is one that we have to live with if the parents say that it is okay for their child to return to action.

If it were my child I do not think that my child would play, but it is the parents' decision in this play.

[Dan_ref]

Originally posted by Mark T. DeNucci, Sr.
This play does not fall under the Referee's elastic clause nor does this fall under the unconcious player rule. The only possible way that that a diabetic siezure might fall under the unconcious player rule is if the player was in the game at the time...

Mark, this is a pretty bold statement. Can you show where
the unconsious player rule only applies if the player is rendered unconsious while he's in the game?

Here's the rule from the 2001/2002 book:

2-8-5 ...Determine when a player is apparently unconciuous.
The player may not return to play in the game without
written authorization from a physician.

Since the term "player" is not explicitely defined I tend
to take a more liberal view of what an unconcious player is.
For the purposes of this rule (IMO) a player is any team
member in the game or liable to enter the game, meaning an
unconcious sub needs a physician's authorization before he
enters the game. Obviously a disqualified player is no
longer liable to enter the game, so he does not need a
physician's authorization.

We have already heard from experts that having a siezure
means you are by definition unconcious. As far as I'm
concnerned, if you're rendered unconcious during the time
of my jurisdiction you will not enter the game without
a doctor's written authorization.

[daves]

Originally posted by Mark T. DeNucci, Sr.
This play does not fall under the Referee's elastic clause nor does this fall under the unconcious player rule. The only possible way that that a diabetic siezure might fall under the unconcious player rule is if the player was in the game at the time. But the play that you described in your posting is one that we have to live with if the parents say that it is okay for their child to return to action.

If it were my child I do not think that my child would play, but it is the parents' decision in this play.

How about this scenario Mark? Player A1 dives out of bounds for a loose ball and runs into bench personnel B3 and B3 loses consciousness from the contact. Are you going to let B3 come into the game without a MD written approval? B3 wasn't a player in your interpretation when he became unconscious. I think this most definitely falls under the elastic clause. I also think the diabetic seizure would also fall under that clause.

[Mark Dexter]

Originally posted by Mark T. DeNucci, Sr.
This play does not fall under the Referee's elastic clause nor does this fall under the unconcious player rule.

Mark, the whole reason why the MD rule is in place is because referees are not (for the most part) certified in emergency medicine. Note the rule: unconscious or APPARENTLY unconscious. Apparently unconscious can mean many things to many people. This is CYA, so that if you think there is the slightest possibility the kid was out of it, he's out of the game.

Check out 2.8.5 - the officials rule that A1 was apparently unconscious, but the trainer/coach disagrees. Ruling - too damn bad!

[Mark Dexter]

Originally posted by Dan_ref

Mark, this is a pretty bold statement. Can you show where
the unconsious player rule only applies if the player is rendered unconsious while he's in the game?

Here's the rule from the 2001/2002 book:

2-8-5 ...Determine when a player is apparently unconciuous.
The player may not return to play in the game without
written authorization from a physician.

Although I don't agree with the spirit of his interpretation, MTD is correct that a player is one of the five team members on the court at a given time (4-34-1).

In your case, though, I'm going to deem the kid unconscious the second he steps onto the court!