First half, we had a kid today (Grade School) who was on the bench go into a diabetic seizure. The coach requests a time out and then runs to this kid who was sitting there on the bench holding his own neck. To those who have not witnessed many seizures, it was a sobering sight. After a couple min, he came out of it and his mom cam over and attended to him. Kid seemed back to normal and he and his mom left the gym. At half time, he rejoined his team and participated in warm ups. I asked the coach if he was ok and he said it's happened before and he should be fine now.

The kid played the 2nd half and seemed fine but I had 2nd thoughts. Should I have let him play? I witnessed this kid basically locked up. I kept my eye on him and several times asked him if he was ok if I had the opportunity.

Is a seizure considered "unconscious"? Would you have let him play?

Larks

I might not have.
 

Only because if something happen to him during the remainder of the game, you might have been blamed for not taking action. I think this is a touch call, but you have the right as an official to rule on anything that is not in the rulebook. And this is not obviously in the rulebook. But if all the other parties were thought that he was OK then I guess you did the right thing with the information that you had.

I guess in these situations you have to do what you feel is right. If think he should not play, you do have the rules and the jurisdiction to handle it. But what I want to know, what the hell was his mother thinking?

Any time a serious injury/incident occurs, I would want a doctor's note. In this case, you could use 2-3, or even 2-8-5 (the unconscious rule). Simply state that, in the judgement of the official, the kid was unconscious. Leave the real medical determinations to someone with an M.D.

So the question: Is a diabetic Seizure a serious injury? I've heard that with a little food or juice, it doesnt take long for the person who had it to come back to "normal" and in my game, this kid seemed normal. But I gotta tell you that I was unconfortable at times. I guess thats why we have insurance but imagine: I let him stay in and he has the big seizure rather than a diabetic type...or he has it while running and falls and cracks his melon. I can see the lawsuit naming me, the school, the coach, the township, county and everyone on this messageboard all because I let a kid who seemed and looked fine to all involved...play.

I think if I had it to do over again, I say "no". These decisions are much easier with the benefit of 4 hours to think about it.

Larks

In my real job, I work as a registered nurse in a hospital emergency room. I have on many occaisions seen exactly what you are talking about. A hypoglycemic reaction or diabetic seizure as you call it is a reaction to low blood sugar. Low blood sugar can have varying degrees of severity. A person may feel weak and dizzy to being fully unconscious. If the player in your opinion was unconscious then I would not have allowed him to return to the game without physician approval. If they were just weak and dizzy but could respond to you verbally, I probably would allow them to return after treatment to raise the blood sugar. Let me add that very few true seizures involve consciousness.

[Edited by daves on Jan 7th, 2002 at 02:30 AM]

Larks,
I think it is unconscionable that an official would have that put on his plate without a warning, guidance or some kind of medical note.
mick

Well, his eyes werent closed and he was sitting on the bench but he was unresponsive to the coach for a couple minutes. Again....mom gave him some juice or whatever and he was back to "normal". This has been some good feedback. I'm still hanging my hat on not again. Just too many medical unknowns to make me think I dont want to be in the loop.

Ya know....I just had a thought....Hey Mom and Coach....if you know you have a kid who goes thru this....mix in a meal before game time!

Larks

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?

My first thought when I saw the thread topic was that I would require a physician's note to let a kid continue. Nothing in the post or responses has changed my mind on that. JMHO. I am not so much worried about liability I just don't want that on my conscious if something were to happen.

My HS nurse's comment about malpractice/liability insurance:

"I have $1 Million in insurance, but I only get to use it once."

In a HS or higher game there would probably be medical staff available to issue a release. In lower style game (such as this) it is hard just to get everyone to understand just the basic rules. Hindsight is always 20-20, but I would have thought hard about letting him play.
Since verbal instructions/agreements are hard to prove, why write in scorebook next to players name "OK to play" and have the mother initial it????

Good thinking on the "getting it in writing." However, I still would not play in this situation. Unless the mother is a physician, I'm unsure if she can clear her son to play. (This is why we require a doctor's WRITTEN authorization to return - if you have medical staff on hand, make sure there is an MD present, and not just an EMT/Paramedic.)

This whole thing with releasing liability came up a while back with a coach willing "take full responsibility" for letting a player play in some state where she should not have been allowed to play. Someone may take responsibility, but that does not mean liability has been transferred!

The idea of Mom initialing beside the name in the book has several issues. Who keeps that book and are they reliable to not "lose" it by accident or on purpose. The other thing about having mom sign off is that if I allowed that, I would not be following NF rules thus exposing myself further to liability.

I would rather take my lumps from the family, fans and coach than live with the potential of something bad happening on a variety of fronts.

Next Time....No Play without a Doctor's note.

Larks - Veteran In Training

Let me ask a few questions. Given that you posted late Sunday night and that you are talking about grade school, is this a rec league game? Are you a parent reffing the game? Are you a certified ref working this game on assignment?

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

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.

[/B][/QUOTE]

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.

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.

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.

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

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..

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

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 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.

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.

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, 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.

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, 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!

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.

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.

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

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.

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.

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

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.

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!

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?

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.

The details again and my suggestion
 

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

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.

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, 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.

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. [/B][/QUOTE]

So now Larks is gonna be running around the court without a left ear? ;)

...do NOT have the authority....
 

mick

Hey!!

JR...Good point....except, please keep my "left one" out of betting considerations. I do have a nice pair of shoes you can bet on for puking rights though.

Larks

If JR were confident, he would have bet his own left ear. Or whatever he was betting.

Mark,I'm confident,but I'm not dumb.Why take a chance?Ol' Larks started this,so let him take the risk.That way it's no skin off my....:D:

I heartily disagree with your assessment of this situation. I think you are getting hung up on a semantical and legalistic interpretation of the word 'player'. If we don't have the official authority to keep a player in a situation like this from playing, we are ethically bound to do so. In the officials manual there is a code of ethics. The last 2 points in this code state, "Officials shall, while enforcing the rules of play, remain aware of the inherent risk of injury that competition poses to student-athletes. Where appropriate, they shall inform event management of conditions of situations that appear unreasonably hazardous. Officials shall take reasonable steps to educate themselves in the recognition of emergency conditions that might arise during the course of competition."

As officials, we not only enforce the rules of the game but we have ethical obligations as well. You cannot do one to the exclusion of the other.

[Edited by daves on Jan 8th, 2002 at 08:34 PM]

Mark, there's a time to use the rule book to the letter and there's a time to use common sense. You are being entirely too legalistic in your approach to this problem. While the rule book may say "player" I'm quite sure it is not the intent of the NFHS to allow a substitute who became unconscious while sitting on the bench to come into the the game. I don't believe you have much of a defense when the boys' parent sue you.

But if you want to be legalistic, I'll give you a different interpretation of the rule. You're being too narow minded in your interpretation. The rule doesn't say that he has to become unconscious while in the game. It says that he can't return to the game if he's been unconscious.

3-3-7
A player who has been determined apparently unconscious shall not return to play in the game without written authorization from a physician.

My Interpretation
If he comes into the game, he is now a player. It has been determined that he was previously unconscious. He is not returning to this game without written consent.

I bet that interpretation will work for everyone else.

For once, use some common sense and interpret the rule sensibly, not legalistically, the way it was meant to be interpreted.

I agreeing with you, but only because the NFHS would probably not read the rules before making a ruling. I know that is a harsh statement to make but that it is what I feel in my old bones. But I still stand my original ruling.

Re: ...do NOT have the authority....
 

No I am not a lawyer (thank goodness), but by rule we have no say in the matter, and I would venture to say that if a parent were to be agressive enough to hire a lawyer, the official would lose.

I agree with you on what it says in the officials manual, but the conditions that occured in the original posting is outside the officials jurisdiction. I have declared two players unconcious: once in a girls' varsity basketball game and once in a boys' varsity soccer game. Neither coach was happy, especially the soccer player's coach and parents. But we sometimes we just do not have the authority do be king for a day. We have to pick our battles and this is not one of the battles that we as officals should be fighting (I mean taking actions per the original posting).

Now trying to get the rule changed, that is another matter and I would have no trouble supporting a change in the rules to have it apply to substitutes.

I agree with you on what it says in the officials manual, but the conditions that occured in the original posting is outside the officials jurisdiction. I have declared two players unconcious: once in a girls' varsity basketball game and once in a boys' varsity soccer game. Neither coach was happy, especially the soccer player's coach and parents. But we sometimes we just do not have the authority do be king for a day. We have to pick our battles and this is not one of the battles that we as officals should be fighting (I mean taking actions per the original posting).

I still totally disagree with what you are saying here. I don't consider protecting a player is being "king for a day". I think it is much more likely for an official to get into trouble for not protecting a player than for making a call that in one person's opinion is beyond an official's jurisdiction.

In prior posts you have stated that you don't think that falls under the elastic clause. I don't have my rule book handy so I can't quote chapter and verse. Are you talking about the rule that says that the referee may make a decision not covered in the rules? If so, why would this not be covered under that clause? If it's because you think that player unconsciousness is already covered in the rules, then let me submit this. Using your own rationale, a person on the bench is not a player, so non player unconsciousness is not covered in the rules. Therefore it would fall under the elastic clause.

Mark,let's say you're watching a game where one of your two sons is playing.Your son is sitting on the bench when he is definitely knocked unconscious by the elbow of a player trying to save a ball from going OOB.When he comes to,his coach immediately subs him into the game.The officials allow the substitution.What is your reaction,if any,as a parent?

Mark,

What is Hank's opionion on this? By NFHS decree rule interpretations are supposed to be set by the state. Whatever way your state interprets the rule, is how you should enforce it. I am guessing they wise men (and woman) here in Columbus would want us to take a more liberal interpretation of the rule.

If my son were knocked unconscious as you just described, he would not even be on the bench, therefore the coach would not have the opportunity to consider subbing him into the game. But that is not the point in this case. In the posted play, the unconscious athlete was not a player in the game at the time. The parent made a decision to let his child play after that.

But another question has not been raised in this matter and I hope that refdoc can answer it for us. Two years ago our 11 yr old suffered a minor concussion while shooting hoops with his cousin. He never lost consciousness in the sense that he was in a coma for any time, but about 15 minutes after the incident and while holding an ice pack to his head he asked me how he had hurt his head. He was suffering from short term memory loss and we took him to the hospital immediately for treament. He was not allowed any type of physical sports activity that might incure contact. That meant swim practice was okay but not racing dives and he could do fielding drills only at baseball practice. When a diabetic comes out of his unconscious state after a seizure at the same risk as a player who has just come out of an unconscious state because of being hit in the head? In other words is his brain at more risk of injury from a diabetic seizure as opposed to from being hit in the head?

(original posting).

Now trying to get the rule changed, that is another matter and I would have no trouble supporting a change in the rules to have it apply to substitutes. [/QUOTE]

MTD: What is the process?

Mark,let's say you're watching a game where one of your two sons is playing.Your son is sitting on the bench when he is definitely knocked unconscious by the elbow of a player trying to save a ball from going OOB.When he comes to,his coach immediately subs him into the game.The officials allow the substitution.What is your reaction,if any,as a parent? [/B][/QUOTE]


If my son were knocked unconscious as you just described, he would not even be on the bench, therefore the coach would not have the opportunity to consider subbing him into the game. But that is not the point in this case.[/B][/QUOTE]No,Mark,that is exactly the point.You would not let some goof-*** coach make the decision in your son's case,but you also say it's OK for him or some clueless parent to make the same decision in ALL other cases?I agree fully with your decision not to let your son play.It's too dangerous.I'd do the same thing as a parent.As an official,though,I'm responsible for the welfare of every player on every team that I do.If I thought different,I'd hang the whistle up to-morrow.I can't really believe that your letting your love of "rulebook semantics" over-ride your common sense in this case.

Diabetes
 

Well, I finally can speak authoritatively on this one! I am a diabetic referee and can tell you that this was not a diabetic "seizure", this was simply a case of low blood sugar which is very commonplace in the life of a diabetic. The remedy is very simple: eat or drink something with sugar in it. I normally slip glucose tablets into my mouth during games just to make sure that my blood sugar doesn't get too low during games.

I realize that you can not expect all refs to understand every disease that is out there but in this case the parents obviously are fully aware of the kids condition and the easy remedy for the problem because this is something that happens several times a week. Let him play. This is different than an injury or physical reaction that occurs during the course of play.

The question dealt with the risks to the brain after a diabetic seizure as compared to a traumatic event. My opinion is that there is more risk to the brain after a traumatic event than after a diabetic event although I have no specific medical evidence to support the notion.

Remember that unconsciousness does not need to occur for a concussion to exist. Often, after a concussion, the player/patient will only complain of a headache or repeatedly ask the same questions even though the question was answered previously. I often hear patients ask "what happened to me" even though I fully explained to them not 60 seconds earlier.

If anyone else has any questions for me on this subject I will be happy to reply to the best of my ability.

Re: Diabetes
 

Chayce, if you are having low blood sugars several times a week, not only your health, but your very life are in jeopardy. Talk to your doctor about how long it takes your liver to regenerate adequate store of glycogen. If my son had low blood sugars several times a week he most definitely WOULD NOT be playing basketball until we had better control of his blood sugar.

But even if the kid only has them once a month, it still takes about an hour or so for the glycogen in the liver to be released, taken up and distributed. Which means that for an hour or so, he is still subject to another low blood sugar which can hit very quickly and cause him to lose consciousness quite suddenly. Even if he is taking large amounts of sugar orally.

As a parent who has dealt with a child who has Type 1 diabetes and participated in sports, I encourage all of you to respect the rule about not letting kids play after an episode of seeming unconsiousness. It is definitely not worth the risk.

Rainmaker,

I appreciate your feedback and want to reiterate that diabetes is a disease that frequently results in low blood sugars if the patient makes a genuine attempt in trying to maintain normal blood sugars of 80-120mg. As such, I personally believe that blood testing is a critical part of the diabetic lifestyle.

I have been a diabetic for 30 years and probably average a couple of low blood sugars per month and detect LBS symptoms very quickly and also recover quickly. My point in this case is that the patient is familiar with what is happening and with their recovery time and this is just a normal part of being a diabetic. I am also in medicine and understand that each patients case is different and I want them to be in control of their life! Not allowing a kid to play if he has truly been unconscious is the right thing to do, but if he has just been a bit weak-kneed and sweaty with an LBS, an official should not take that control away.

Re: Re: Diabetes
 

Well put Rainmaker. It comes back to risk. The underlying question for me....Is this child at RISK for another episode on my watch? I submit he is and therefore I should take steps within my authority to protect him from potential injury in the same way you would protect a kid with a concussion. I'm sticking to my guns....If I see this again, I wont let him back in.


One other point that hasnt been made here....We are talking about ONE GAME with the key emphasis on the word GAME . Heck, maybe even a quarter or a half out of a whole season. Is it really worth it? Have a seat son, theres another game next week....and mix in a meal for cryin out loud!

Larks - Veteran In Training

Chayce....in this case, the coach said it was a diabetic seizure and that it happens from time to time. I personally witnessed this kid with his hand grasping his neck almost as if he was choking....basically locked in that position for about 2 minutes.

Thats a little more than weak-kneed and sweaty IMHO.

I do appreciate your perspective on this and respect that you have your situation under as much control as you can. See my previous post though....we're talking about 1 game.

Larks

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Chayce, I took the words in the original post "seizure" and "holding his own neck" to mean worse than just sweaty and weak-kneed.

But my real point is that, as others have said, there if no way for a ref to know and understand the various diseases or injuries that may cause unconsciousness. If the ref decides the kid is unconscious even once, then the kid is out. Period. This is because the risks aren't worth it.

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Juulie - were you having a seizure while typing this post?

No, everyone in my family has diabetes EXCEPT me. (and my daughter, but she's adopted). I was just keeping the contributions of my charming little rugrat limited to a place where they "won't affect the play."

It's amazing how much you reply when it the topic is something this personal but I would like to make one more comment:

I see this as analagous to a player with asthma. I had a situation last week when a player had an asthma attack and was choking during the game. He never went unconscious although his breathing was very labored. I immediately stopped the game and asked the coach to assist the player which he did by providing an inhaler. After substituting a new player, we re-started the game with the old player on the bench recovering.

After approximately 3-4 minutes, the coach reinserted the "asthma" player back into the game. I DID NOT ask for a doctor's note! The player new what was happening, sought treatment, and came back into the game. A diabetic with LBS seeks treatment and comes back into the game! I promise that is my last post on this one. Please know that I am also in full support of everyone's effort to make safety a top priority! In this instance however, it is not just one game; for a diabetic, this could potentially happen every game and the patient engages in self treatment as part of the medical plan!

Thanks

It's great to see that they're posting on this board at such a young age! Now all they need to do is get out on the court, and they'll have NBA games by the time they turn 18! :D

Re: Diabetes
 

Chayce, I can also speak authoritatively on this subject as an emergency room RN and I disagree with you. You can in no way state that it was not a diabetic seizure. You weren't there so you don't know how profound the person's hypoglycemia was. Consciousness as well as hypoglycemia(low blood sugar)has varying degrees as you well know. In your case, you recognize the symptoms early and intervene with some extra glucose. I have seen patients who were profoundly hypoglycemic and are completely unconscious. I have also seen patients whose blood glucose is slightly low and had a slight alteration in their level of consciousness. If a patient comes into the ER for a hypoglycemic reaction that resulted in loss of consciousness they would be there for an hour or longer and have serial monitoring of their blood glucose. They would be given a meal after their blood glucose was increased by IV administration of concentrated glucose and watched for a while. In the original scenario, I would conclude that the person was unconscious ,or had been unconscious, as the coach stated he was having a diabetic "seizure". As has been been stated earlier you cannot have a conscious seizure. You also state that the remedy is simple in eating something with sugar in it. Wait just a minute. I would NEVER give an unconscious person ANYTHING to eat or drink. You run the risk of aspiration and death. I would be seriously hesitant about giving a minimally conscious person anthing by mouth either. By the way, I tend to get hypoglycemic at times too and my dad is an insulin dependent diabetic. I know what to watch for and treat it before it gets too bad.

I do not consider an unconscious person from hypoglycemia analagous to the asthmatic player who uses their inhaler and returns to the game. If that asthmatic player became unconscious as a result of their asthma I would not allow them to return to the game without a physician's note either. I have seen people die from asthma. It can be a serious medical condition.

[Edited by daves on Jan 10th, 2002 at 05:55 PM]