Causing concussions
 

Had this happen during Girls' Varsity the other night....

First quarter, visitng team shoots & misses, home team goes for rebound, in the process of home player rebounding, a visitng player pushes her while she's in mid-air where she slams into the wall & collapses on floor in a heap. Floor officials called an officials' timeout, Home HC attending to player who didn't respond/move for about 5 minutes. Finally player gets up showing signs/symptoms of concussion.

Play continues on at POI, no foul charged to visiting team for excessive contact.

Home player was assisted back to bench with help of coach, but stays at bench.

How should this play have been called? Should EMS have been contacted, with stoppage of play until EMS removes injured player?

Am wondering if the proper step(s) were done, since I am questioniing the situation, after viewing the WIAA Online Rules Clinic & the information about the Zackery Lystedt Law concerning concussions.

More information about the Zackery Lystedt Law can be found at: http://wiaa.com/subcontent.aspx?SecID=623

The NFHS published this a couple of years ago.


Point of Emphasis for 2006-07
Proper Procedures for Handling Apparent Concussions

ACTION PLAN
If you suspect that a player has a concussion, you should take the following steps:

1. Remove athlete from play.
2. Ensure athlete is evaluated by an appropriate health care professional. Do not try to judge the seriousness of the injury yourself.
3. Inform athlete's parents or guardians about the known or possible concussion and give them the fact sheet on concussion.
4. Allow the athlete to return to play only with permission from an appropriate health care professional.


SIGNS AND SYMPTOMS

These signs and symptoms may indicate that a concussion has occurred.

Signs Observed by Coaching Staff

• Appears dazed or stunned

• Is confused about assignment

• Forgets plays

• Is unsure of game, score or opponent

• Moves clumsily

• Answers questions slowly

• Loses consciousness

• Shows behavior or personality changes

• Can't recall events prior to hit

• Can't recall events after hit

Symptoms Reported by Athlete

• Headache

• Nausea

• Balance problems or dizziness

• Double vision or fuzzy vision

• Sensitivity to light or noise

• Feeling sluggish

• Feeling foggy or groggy

• Concentration or memory problems

• Confusion

She was removed from play, but she was just assisted to the bench & sat down, without, from what I could tell, someone closely monitoring her for the rest of the game. Like I said in my initial post, the HC went to her side after the officials called for time. It was the HC that assisted her back to the bench. EMS was not called, nor was there an Athletic Trainer on-site to do proper evaluation.

Below, in your reply I've put in bold what I saw as signs/symptoms.

I was at halfcourt, behind the scorers table when the incidence happened. I did have a clear line of sight however to see the proceedings.

As an official, what I'm concerned about is:

1. Making sure someone is penalized if a foul is committed and to make sure said player is appropriately punished (common foul, intentional, flagrant)

2. Make sure hurt player is attended to and given as much time as necessary. If an EMS is called, then we're probably waiting till they arrived and the player is taken from the scene.

3. If an EMS is not called and if I deem that hurt player appears to have lost consciousness, that he/she will not allowed into the game without a note from an M.D.

Beyond that, I'm note sure what else we can do.

Once the athlete was removed from play, game management should have taken over and gotten her the medical attention that was required.

If a coach suspected a concussion, then he could ask for an on-site trainer (which you say was not present) or arrange for transportation to another location for proper evaluation via a parent or responsible adult (EMS/REMSA is probably not necessary).

Game officials try to stay out of medical matters as much as possible.

AllPurposeGamer,

Here in Washington State, there's a brand new law on the books called the Zackery Lystedt Law that has to deal with concussions in Interscholastic Athletics. Part of the law is that, if a concussion happens (losing consciousness or not), the student-athlete cannot practice nor participate in games until cleared by a medical professional that has the training to diagnosis & deal with concussions. The law was signed into effect by Gov. Gregoire this past summer.

How I saw the play occur, the home player was in the air going for the rebound, when the visiting player made physical contact by pushing/shoving the home player OOB & into a padded wall. When the home player hit the padded wall, a loud thud was heard throughout the gym.

I'm questioning whether they should of moved the player, & not just called EMS to get her examined. It was the HC at her side as soon as the officials whistled for stoppage of play, who decided to get her up on her feet & assist her over to the bench.

When the home player was finally mobile, & assisted to the bench by the HC, play continued on as normal from the POI, no fouls were assessed for the contact/pushing/shoving.

When I go in Saturday to work the Wrestling Invite & Boys' Games, I'll ask the AD if any medical attention for the player was sought. I'll just explain that I'm concerned, especially after reading the WIAA Online Rules Clinic & the information regarding the Lystedt Law concerning concussion management in interscholastic activities. I have a couple of Neurological disorders, & I have been told several times never to mess around with an injury to the head.

Why are you questioning that? It's not your decision to make.
Are you aware that student-athletes all have to have parents/guardians sign medical release forms at the start of the season? Someone on that form is designated to act in the best interest of injured players. If the parents were in the stands, they could be consulted BY THE COACH. Everyone else besides trained medical personnel who are prepared to handle such matters should stay the heck out of it.

As I stated before, I have a couple of Neurological disorders, & I have been told several times never to mess around with an injury to the head, or when a loss of consciousness occurs.

As I stated earlier, I did not know of anyone there that was trained medical personnel. I did not see the proper precautions/procedures being put into action.

When I was Boys' Basketball Manager back in 1997-1998, I saw a similar play happen, with similar results. Only the player got shoved head first into wood bleachers.

I know of the medical release forms from participating in track in 8th grade.

When I was going through the area of the WIAA Online Rules Clinic dealing with concussions earlier, I couldn't stop thinking of the situation, of what should of/could of been done differently.

I cannot help if I am concerned about a person's well being/safety.

Why did you not call the foul?

You seem to be suffering from a guilty conscience more than anything. What do you expect people here to tell you? You seem to think you have some sort of responsibility for determining whether medical attention was necessary for this girl. So why didn't you do something? What is the answer you need to hear?

I understand that, but we as officials do not deal with injuries besides what we must by rule per NFHS. That means we'll stop play when appropriate (in this case, play would be stopped immediately). What happens after that is up to coach/trained personnel. The only decision as an official that has to be made is whether consciousness was lost or appeared to be lost. In that case, we aren't allowing the player back without a signed note from an M.D. You're asking the wrong people whether or not the correct procedures were followed.

CHS - I'm with Smitty. I'm not sure what you want us to say/do.

I'll either call the foul or not. I'll clear the floor and send the players to their benches. I'll let the team and game mgt attend to the player. If they think EMS or an ambulance is needed, their call. If I think the player was unconscious I will inform coach of the rule. Clear the player off the floor by whatever means the team/medical feel is required. Secure a replacement player and get the game moving.

I am not taking charge of any medical situation nor giving advice. I do not play a doctor on tv and I did not sleep at a Holiday Inn Express last night! ;)

I believe the OP is not an official.

Well that explains why they didn't call the foul. :o

I still don't know what they expect anyone here to say. The OP should be asking the school officials why they didn't call EMS.

The OP is NOT an official. He works the table and is very curious, not in a bad way (IMO), as to what officials do, why they do it, etc.

My rub with the OP, and I get the feeling from some of the other posters too (although obviously I don't speak for them) is CHS doesn't seem to like or accept the answers he hears and continues question, pick, disagree, etc. Never seens satisfied with what is said.

Oh well, it's a free world and has made for some interesting banter from a slightly different angle. My $.02.

What exactly are you asking us as officials? We cannot control what happens to a player (other than denying re-entry into the game) after a player is injured.

I was asking for thoughts &/or opinions as I was figuring some on here might have coached before becoming officials.

Basically I was asking, if you were in the coach's shoes, how would you have handled the incident?

If you've had previous playing experience where something like this happened, what would you, from a player's POV, have wanted the coach to do?

The incident happened Tuesday night, I've giving the coach the benefit of the doubt that medical attention will be sought (although I am thinking it should of happened immediately afterwards). When I go in on Saturday to work crowd control for the Wrestling Invite & Scoreboad/Timer/Shot Clock/Crowd Control for the Boys' Basketball Games, I'll be asking the AD if the procedures are being followed as how I understand things & get his input as well.

I'm not convinced that was your motive when you originally posted - I think you changed your perspective once you got a bunch of answers you didn't want to hear. If you wanted a coach's perspective, why didn't you just post the question in a coach's forum?

I am again wondering what answer would satisfy you? :confused:

Am just trying to get thoughts &/or opinions on how different people would of handled the situation, if they were in the HC's, player's, &/or parents' shoes.

I'm a bit angered at the HC for how he handled the incident, but at the same time the benefit of the doubt should be given as I know he's been HC for at least 20 years. It's because of giving the HC the benefit of the doubt, that I haven't gone up to the school, continually questioning the HC about how he handled the situation.

I realize after rereading my original posting that I did leave out some stuff, that I added in later postings. That my reasoning for asking was not being clearly identified.

Consider that the HC has "been there done that." It's like being a parent. With the first child, you panic at the first sneeze and come running at the first wimper. By the time even your second child is a toddler, you learn wich cries require attention and which ones are best ignored. Do you always make the right choice? No.

Also, your OP insinuated the officials purposefully didn't call something. By your description, a foul should have been called. However, I would bet money the official didn't see it the same way you did, or he would have called the foul.

If I was right there in front of the play, I would of seen things a bit different. Unfortunately I was not. I know there's going to be differences as to how plays are seen depending on a person's POV. As how I saw it, the visitng player forcefully pushed the home player, but if I would of viewed the play from right next to it, it could of been that the visiting player had enough momentum that although she had stopped, her body or arm had enough residual energy for the result to occur as it did.

I don't mean to hijack the thread, but your remark reminds me of the following definition from the Parents' Dictionary:

sterilize: vt. What one does to one's first baby's pacifier by boiling it, and one's last baby's pacifier by blowing on it.

Or, both players were jumping into each other and therefore neither could rightfully be called for a foul. All sorts of possibilities. I am glad you recognize that, though.

HC: Evaluate the situation and call for medical / trainer assistance if needed. That was apparently done (and decided it wasn't needed).

Players: Get back to the game.

Parent: Assess the situation from the stands and decide whether to get involved. Probably not given the information you've given us. No way of determining whether this was done.

There's no way for any of us here to decide whether the coach's actions were in any way deficient. That's why none of us has given an answer that you seem to want. And, unless you're trained in this, my advice would be to STFU about it (at your school).

I'm just trying to get an appropriate interpretation as to the new Concussion Management regulations, considering it's a state law now. From my understanding, the Lystedt Law is the first of it's kind in the US.

Like I stated above in my previous post, I'm giving the HC the benefit of the doubt that after the game he took the additional steps needed. When I go in Saturday, I'll be asking the AD if the player's alright, mentioning the fact I am concerned about her health/well being, especially after reading the WIAA Online Rules Clinic section concerning concussion management. This way, I can get an in-person interpretation of what I read, so that I can have a better understanding.

My alma matter is located in a small farming community, & I'm sure I'm not the only spectator that's concerned about the player.

These concerns would be more appropriate for the AD, principal, or school board.

Unless the law requires you, in whatever role you had at that game, to get involved, then your interpretation, just as with the assistant coach checking the book, should be to ignore it.

Look, I like people who do more than the minimum. I don't like people who say, "it's not my job." But, you need to recognize that not every little thing that goes on in the gym is something that you should get involved in.

I was just a spectator to the events, as the whole time I was behind the scorers' table as crowd control to make sure no unauthorized personnel went into the locker room area.

I have been rethinking things, & came to the conclusion that I feel that way I do because of having the different neurological conditions, & being told by numerous medical personnel to not take a neurological injury lightly.

Like I mentioned, in an earlier post, I'll ask the AD how the player is doing, & stating my reason is due to my reading the new Concussion Management Regulations & my understanding of them, also that I am concerned for her safety. Hopefully, by asking him about the new Concussion Management guidelines, I can get a clarification of the regulation.

Okay, go for it. We don't care what you do at this point.

I do have a general question about concussions, though. I don't have my rule book, so I am not sure of the exact wording, but doesn't it say that a player with a concussion may not return without a doctor's permission. Does this mean for that particular game or for any further games? If it is for future games, how do you know? Do any states require the officials to file a report with their assignor when it appears a player received a concussion so that the crew doing the next game is aware? Or is that something that becomes a game management issue that we don't want to deal with. Seems to me it would be very hard for us to enforce and it's something I never had a crew talk about in a pre-game.

The rules do not talk about concussions. The rules talk about a player who is, in the opinion of the official, apparently unconscious.

Here in Washington State, we have a new law that just got passed this past summer. The Zackery Lystedt Law is named after a young man who went back into competition after suffering a concussion & now is in a wheelchair.

More information about this can be found at: WIAA | Washington Interscholastic Activities Association

How it is written, if a student-athlete suffers a concussion, they are not allowed to practice or compete until they are clearing by a medical professional trained in treating concussions.

On the website listed above, I am not seeing anything concerning official resources, it wouldn't surprise me however if the WOA does have something.

The CDC resource sheets also state that the student-athlete needs get approval from a medical professional to return to competition/practice after suffering a concussion.

I'm sorry if I'm coming across rudely, but you've told us about this law at least three times now. What is it that you need to know from this officiating forum?

johnnyrao,
As others have said, the only time we need a doctor's note is when the player has been unconscious.

I want to know one thing. If you are working the table, what are you doing looking down at the end of the bench at the player? How many times do I say, you need to focus on YOUR job?

I wasn't working table during the Girls' V game. I was crowd control.

No Trainer
 

From a basketball officiating standpoint there's not much to add, but I'm curious as to why there was no athletic trainer present. In MA (I believe) it's a requirement to have a trainer at the game. Usually teams don't travel with a trainer but the home team trainer will cover both teams and certainly would have been involved with a player who doesn't get back up after a hit.

Seems odd, there is a law about concussions and further participation in the state but no requirement that someone qualified be onsite to provide care?

Fixed it for ya. ;)

Right. And, they apply only for that game. There's no way, as Johnnyrao suggested in his question, for us to know or enforce what happened in a previous game. I'd guess that the same is ture in Washington, with whatever that law is called.

From The Archive King ...
 

However, as Nevadaref was so kind to post earlier, there was a NFHS Point of Emphasis a few years ago:

Point of Emphasis for 2006-07
Proper Procedures for Handling Apparent Concussions
If you suspect that a player has a concussion, you should take the following steps:
1. Remove athlete from play.
2. Ensure athlete is evaluated by an appropriate health care professional. Do not try to judge the seriousness of the injury yourself.
3. Inform athlete's parents or guardians about the known or possible concussion and give them the fact sheet on concussion.
4. Allow the athlete to return to play only with permission from an appropriate health care professional.

As I recall, initially there was some confusion about the identity of "you", and the NFHS later came out with an interpretation that "you" did not refer to the officials, but, rather, to the coach, site director, trainer, etc.

It doesn't apply to the scorer or the locker room guard? Zackery Lystedt will be disappointed to learn this.

It's Not BillyMac, M.D. ...
 

That's who the "etc." was referring to. Anybody, but not the officials.

Chseagle,

Not to get too personal, but you've made several references to your neurological conditions and now some references to your 8th grade track and field days. Care to elaborate on what exact neurological conditions you have? Is Aspergers one of them? How far removed are you from the 8th grade track program? How long have you been out of high school? What is your exact job at the table? Help us to better understand where you are coming from.

The reason I ask all this: I have a friend who tells everyone he works at xxxx Fire/EMS Dept. with me. When people start asking questions, he backs down to well he washes the fire trucks. Really, he has Asperger's. He can't work. He is a great guy and hangs out with us as much as he can. You and your posts remind me alot of him.

If we know more about you, maybe it would help us understand what you are looking for. Most of us are referees. We want to be better referees. When someone joins a referee forum that is not a referee, it is best to clearly and honestly explain your exact relation to the game and what you are looking for here so we can more clearly understand you.

From my understatnding, here in Washington the only interscholastic sport where any medical personnel are required to be on-site is for football. For as long as I can remember, my alma mater has not had an Athletic Trainer.

I've researched some more stuff online, besides the WIAA website, everything I've been reading refers to the player's coach.

The two neurological disorders I have: are seizure disorder & hydrocephalus (excess CerebroSpinal Fluid on the brain). The seizure disorder is being treated with medication & diet. The hydrocephalus is being controlled with a VentriculoPeritoneal (VP) Shunt. The seizure disorder I had more severely when I was an infant, but it subsided until after I was out of school.

For high school, I am considered a member of the Class of 1999 but due to complications of the hydrocephalus in my freshman year, I was unable to graduate high school, but do have a GED. My 8th grade year would of been 1994-1995. In 8th grade track, the events I competed in were shot put & discus. I did track on 8th grade, to see if I could handle it or not, as a personal dare to myself.

Due to the hydrocephalus, I am prohibited from participating from any sport considered to be a contact sport (any Interscholastic Athletic except: Track & Field, XC, or Swimming) as a player. However I can participate as bench personnel (team manager or statitician). In high school I was both Football Manager & Boys' Basketball Manager.

Thanks Bob, clears it up for me.

Found out tonight, that thankfully, the player didn't have a concussion as I hsaw her practicing with the team, before the Boys' games.