Diabetic Seizure, Return to game?

[Dan_ref]

Originally posted by Mark Dexter

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!

That's exactly my point.

[firedoc]

I have been refereeing basketball for 6 years. So far I have not witnessed any serious injury or illness on the court (or in the stands for that matter). No one in the gym knows that I am a physician except for my partner because it usually comes up in discussion before the game. I would certainly have absolutely no problem intervening in a serious situation. For routine matters I let the school staff deal with the issue (coach or trainer).

As far as me being the one to authorize a player to return to the game after appearing to be unconscious: NO WAY! I would have to be slightly off my rocker to get involved in a decision like that in that situation. I believe that the rule was meant to lead to a delay so that there would be almost no way for the unconscious player to get back in the game.

In addition, when I treat an athlete in any sport who lost consciousness, I always order a CAT scan and then, if its negative, send him home. The kid always wants a note to return to playing competitively. I always refuse and tell them they should not play again for at least 10 days. I also insist that the player be seen by a neurologist before they can return to compete.

[Larks]

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.

Mark, Being an "old guy" and a fellow Ohio official, I appreciate your contributing to this thread.

Yes the kid was on the bench but we stopped play to allow the coach and ultimately mom to attend to him.

Based on what the medical guys are saying here, a seizure = unconscious. I think I took a gamble that didnt hurt but if I have to do over again, I think I'm not going to allow participation after a situation like this.

Like I said in an earlier post...Coach and Mom need to mix a meal in for this kid about an hour before game time!

Its amazing how many different things you see working just 43 games which is what I am up to this season.

Larks - Veteran in Training

[daves]

Originally posted by Mark Dexter

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!

I'm not even going to let him step onto the court. I know by the most literal interpretation of the rule, he is only a player when he comes onto the court. I think the spirit of the rule has to be addressed. The players' safety has to have a higher priority than a literal interpretation of this rule.

Here's another scenario. Player A1 becomes unconscious during the game. He is removed from the game and one of the parents who is a dermatologist(qualified physician) in the stands gives this player a written authorization to return to the game. I'm still not going to let that player back into the game. There is nothing that says that you have to honor this physician's authorization. As firedoc stated you can't have a complete neuro exam courtside. The player will not play if I am officiating, period. I will always err on the side of player safety.

[daves]

Originally posted by 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....

I disagree that you cannot be unconscious and sitting upright. My mom is epileptic and has petit mal seizures. When she is has these seizures she is sitting up, her eyes are open and she is even talking. What she says is totally inappropriate to the conversation that is going on. Is she conscious? No. When she snaps out of these seizures she is totally unaware of what she said or what happened.

I also wouldn't rely on parental permission, at least not according to NF rules where an MD's note is required. There is not a physician I know that would let a player play after being unconscious, at least from a head injury.
The diabetic thing is another story. Some would let them play after they have recovered sufficiently. Most probably would not.

As far an not being dangerous to others, I disagree as well. When a person has insufficient blood sugar, their brain does not function properly. I have had patient's in the hospital with low blood sugar throw a punch at me. When they have recovered they never remember they did that. You could loosely relate low blood sugar with being extremely drunk.

In regards to your 4th point. Yes diabetes can be manageable but You don't know when or if this low blood sugar condition is going to recur. I don't consider it punishment to exclude a player if he is a threat of harm to himself or others. I consider it protection.

You can't rely on the player to exhibit proper judgment in situations like this. As far as the parents are concerned, if they let this child play after having a diabetic reaction like this, a person could make a very strong case to report this as child abuse. If I had a child with a condition like this, if they had any low blood sugar reaction I would insist that the coach pull them from the game and sit them for the rest of the game. I would do everything I could to prevent it such as giving the child a meal before the game. Check their blood sugar prior to the game or adjusting their insulin dosage times.

[rainmaker]

I am checking in a little late on this thread -- Why does real life have to keep interfering with my addiction!?!?!?

My sister, my husband, my husband's sister, and two of my sons have diabetes, all type I (except my husband who has some weird hybrid that no one understands). Thanks, Padgett, for making the distinction. My older son was 10 when he was diagnosed, and was participating in gymnastics and soccer. He never became unconscious because we were very, very attentive, but I appreciate the problems this mom may have had convincing her son to cooperate with the routine needed.

From my experience, I would not let the kid participate again in that game. If his blood sugar is low enough for him to roll his head back, it will be very unstable for the next two or three hours, and could easily drop that low again, even with careful treatment. He needs CONSTANT physical attention for several hours, to get back to normal, and participating in any sport will be very counter-productive.

Also, if the ref forbids participation for the rest of the game, maybe it will give the mom some ammunition to get him to co-operate better with his care plan.

I'm also trying to figure out how to, within the scope of my reffing duties, advise this mother that she needs a more aggressive doctor who will empower her more firmly to be more in control. This situation is very harmful to the child, in the long term, and should be avoided at all cost in the future.

WOW!! Someone really pushed my buttons this time...

[Edited by rainmaker on Jan 8th, 2002 at 03:59 AM]

[Larks]

Originally posted by rainmaker
I am checking in a little late on this thread -- Why does real life have to keep interfering with my addiction!?!?!?

My sister, my husband, my husband's sister, and two of my sons have diabetes, all type I (except my husband who has some weird hybrid that no one understands). Thanks, Padgett, for making the distinction. My older son was 10 when he was diagnosed, and was participating in gymnastics and soccer. He never became unconscious because we were very, very attentive, but I appreciate the problems this mom may have had convincing her son to cooperate with the routine needed.

From my experience, I would not let the kid participate again in that game. If his blood sugar is low enough for him to roll his head back, it will be very unstable for the next two or three hours, and could easily drop that low again, even with careful treatment. He needs CONSTANT physical attention for several hours, to get back to normal, and participating in any sport will be very counter-productive.

Also, if the ref forbids participation for the rest of the game, maybe it will give the mom some ammunition to get him to co-operate better with his care plan.

I'm also trying to figure out how to, within the scope of my reffing duties, advise this mother that she needs a more aggressive doctor who will empower her more firmly to be more in control. This situation is very harmful to the child, in the long term, and should be avoided at all cost in the future.

WOW!! Someone really pushed my buttons this time...

[Edited by rainmaker on Jan 8th, 2002 at 03:59 AM]

Wow, great feedback. My view on this continues to be strengthened. There is a chance I see this team again so there is a remote chance we go thru this again. I'm sticking to the plan. No re-entry. I've learned alot about officiating and more importantly about my responsibily on this thread. Thank you to all who have contributed especially from the medical / diabetic side.

Larks

[Mark T. DeNucci, Sr.]

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.

I will bow to the good doctor's medical information concerning diabetics and unconsciousness. But in the play posted, the diabetic athlete was not a player at the time of the seizure. NFHS R3-S1-A1 defines that there a team consists of five players, one of whom is the captain. NFHS R4-S34-A1 defines players as the five team members who legally on the court at any given time. NFHS R4-S34-A3 defines when a substitue becomes a player and when a player becomes a substitute.

Therefore, NFHS R2-S8-A5 (unconscious player rule) does not apply here, and I would seriously advise not trying to invoke NFHS R2-S3 (elastic clause rule) to this case.

I share the doctor's concern about letting this child playing in the game but we has officials do not have the authority to deny him entry into the game.

[Mark Dexter]

Originally posted by rainmaker
WOW!! Someone really pushed my buttons this time...

And for once it wasn't your kids helping you type !

Mark, as for the player designation, the rulebook technically does state a player is one of five on the floor, but 2-8-4 states that an official must notify the coach then notify the player on disqualification. If you then go back and read 4-34-3, you will find that once the coach is informed, the player is no longer a player, but is bench personnel. The semantics of "player" should NOT get in the way of the safety of those involved!

[Dan_ref]

Originally posted by Mark T. DeNucci, Sr.

I will bow to the good doctor's medical information concerning diabetics and unconsciousness. But in the play posted, the diabetic athlete was not a player at the time of the seizure. NFHS R3-S1-A1 defines that there a team consists of five players, one of whom is the captain. NFHS R4-S34-A1 defines players as the five team members who legally on the court at any given time. NFHS R4-S34-A3 defines when a substitue becomes a player and when a player becomes a substitute.

Therefore, NFHS R2-S8-A5 (unconscious player rule) does not apply here, and I would seriously advise not trying to invoke NFHS R2-S3 (elastic clause rule) to this case.

I share the doctor's concern about letting this child playing in the game but we has officials do not have the authority to deny him entry into the game.

Sadly Mark you are giving incredibly bad advice here. As
officials on the floor we have not just the authority
but the responsibility to ensure the safety of the
particiants under this NFHS rule. And in a game being
played by grade school children we have a moral duty to
make sure cooler heads prevail, ie keep the kid on the
bench. Now, what about this play:

In an attempt to prevent the ball from going OOB player B1
collides with sub A6 during playing action. A6 is bleeding
from the head and both B1 and A6 are judged by the
officials to have been rendered unconcious. The referee
tells coach B that B1 may not return without written
doctor's authorization. He tells coach A that A6 may return
as soon as his head stops bleeding. Has the referee done
the right thing?

[Mark T. DeNucci, Sr.]

I am the father of two sons (8 and 11 years of age) who are play basketball and baseball, and swim on our YMCA team. I consider my concern for a player's well being second to none. But, in the posted play, the officials do NOT have the authority to over rule a parent's decision (no matter how misbegotten it is).

I know that my position is not a favorite position, but in this case we legally have no standing in the play.

[Larks]

To reiterate:

5th Grade game, first half. A6 had played but was on the bench at the time. Right before an inbounds play A's coach calls out to me that he needed a time out b/c he had a problem with a kid. I looked over and see this kid sitting there. Head down with his left hand grasping his neck. I say "no prob, whats wrong?" The coach informs me that A6 is having a Diabetic Seizure. We stop the game...send the kids to their respective benches while coach and mom (came out of the stands) attend to him. He did not move from this position for several minutes. After a couple min, he comes to. He and his mom leave the gym area. His coach informs me that this happens and he will be fine to everyones relief.

The key thing here to me is that I didnt have to determine he was unconscious or that he was having a diabetic seizure...his coach told me he was and that this has happened once or twice before. So as an official I was told by a team representative that a team member had a seizure which according to the med folks above equals unconscious.

Half time...A6 participates in warm ups and starts the 2nd half. He seemed like every other kid out there...no signs of any problems.

At first, I was ok with my decision but it was after a couple hours of reflection and reading the replies here, I feel I should have not allowed him to return with all due respect to MTD and the rules regarding players and team members. If there was a Doc in the house willing to sign off...thats different.

I think a rule change should be made in the NF to say ANY TEAM MEMBER rather than ANY PLAYER who is unconscious in the officials judgment can not return. I like the word judgement because it gives us lots of wiggle room to make a decision.

Larks

[Jurassic Referee]

Originally posted by Mark T. DeNucci, Sr.
I am the father of two sons (8 and 11 years of age) who are play basketball and baseball, and swim on our YMCA team. I consider my concern for a player's well being second to none. But, in the posted play, the officials do NOT have the authority to over rule a parent's decision (no matter how misbegotten it is).

I know that my position is not a favorite position, but in this case we legally have no standing in the play.

Mark,I would bet Larks' left one that if you sent a play to the Fed detailing a sub on the bench being knocked unconscious,they would tell you not to let that sub play unless a doctor OK'd it.That's the spirit and intent of the rule,i.e.player safety.

[Dan_ref]

Originally posted by Mark T. DeNucci, Sr.
I am the father of two sons (8 and 11 years of age) who are play basketball and baseball, and swim on our YMCA team. I consider my concern for a player's well being second to none. But, in the posted play, the officials do NOT have the authority to over rule a parent's decision (no matter how misbegotten it is).

I know that my position is not a favorite position, but in this case we legally have no standing in the play.

Well let's just leave it at this: I don't have a problem
that we disagree, and usually when I disagree with you
it turns out I'm wrong. My problem is that you have taken
the positon of absolute authority in this matter, and there
are lots of rookies and people who do nothing but "little
kid" rec ball who might get a kid into deep trouble by
following what you say to the letter in this case. I mean,
we're discussing something a little bit more critical than
what constitues a simutaneaous multiple foul.

Secondarily, since you mention what we can do legally,
there are many lawyers out there who make lots of money
helping juries decide the defnition of "legal
responsibility". As you say, a rigid reading of the rules
might get you off the hook, but there's a big
difference between what's written in a rules book and
what a reasonable person might be expected to do.
Convincing a jury that you did the right thing is pretty
costly.

[Mark Dexter]

Mark, what would you do with 3-3-6? A player who has too much blood on his uniform needs to leave the game. If A7 was picking a scab, bled all over the front of his white uniform, then tried to enter the game, would you let him? Remember, he's not a player until he legally enters the court, so you need to have him come on to the court before you direct him to leave.