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  #61 (permalink)  
Old Wed Mar 03, 2010, 10:39pm
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Quote:
Originally Posted by Ed Hickland View Post
Good find. A player vomits, is it a concussion, or, did he eat too much, or, could be heat related. You would have no idea that 2 pound burger he ate upset his stomach but it could be a concussion symptom.

Or, confusion. How many times have you seen some player appear confused? Is it natural?
Early signs of dehydration, heat cramps and heat stroke include the following. See anything in common?

fatigue
thirst
dry lips and tongue,
lack of energy
painful cramps
dizziness
nausea
vomiting
headaches
weakness
muscle pain
unconsciousness
seizures
disorientation or delirium
lack of sweating
shortness of breath
unconsciousness
coma
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  #62 (permalink)  
Old Thu Mar 04, 2010, 10:54am
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Originally Posted by Ed Hickland View Post
Al, you are missing the point Rut, myself and others are stressing. Officials becoming the primary examiner of player condition, is something we are ill prepared. I would ask if you know the obvious signs of concussion but since you are omnipotent I know that answer. For the remainder of us to ask that we pay close attention to something we have limited to no knowledge is unfair and places us in a delicate position.

I have sent players off the field when it is most obvious they have a problem, the best example is the blood rule, but to ask a football official to be cognizant of the signs of concussion is beyond my pay grade especially considering medical professionals with years of training cannot agree on what to look for. Concussion symptoms are not like blood, compound fractures, dislocated fingers, shoulder separation, etc. that are clearly visible, or, even like a torn ACL where the player openly feels pain. Concussion symptoms are silent, a player may appear to be fine, he may return to the huddle and participate in the next play because concussion involves cognitive functions that may not be apparent.

The point you make about sending a player off because of obvious signs and behavior has no merit when discussing concussions.

If a player sustains a concussion and continues to play only to later express signs lets say after the game would officials be liable because the signs were not recognized. I believe that is the frustration most of us are expressing.
Ed, from where do you get the notion that anyone has a rational expectation of, "Officials becoming the primary examiner of player condition". Sorry, but even if you stay at a Holiday Inn Express, you have to finish medical school and/or be certified at some clinical level to assume those responsibilities.

Anyone assuming you are somehow automatically qualified to render accurate diagnosis is a complete fool, including any attorney who wants to hold you responsible for being something you have never claimed to be, or there is no reasonable expectation that you automatically are. As previously suggested, the irrational fear of what some bogeyman attorney "might" do, creates little but unnecessary paralisys.

Forgive me, but it shouldn't take you longer than 30 seconds to, "be cognizant of the signs of concussion", which is a whole lot different from diagnosing potential concussion. You are not a doctor, stop trying to convince yourself anyone will ever presume you are an "appropriate health-care professional".

With all due respect to, and appreciation for, Mayoclinic.com, their list of concussion symptoms, in situations, where they are being displayed at an obviously problematic level, are and have long been, worthy of sending a player off for evaluation, regardless of what might actually prove to be causing them.

The point being missed may simply be that you are getting way, way ahead of yourself conjuring up all sorts of exaggerations that that will likely never, ever be part of any (actual) expectation or rule. If some of your wildest concerns do make it to the final rule wording, they will have to be addressed and dealth with, but as of now, based on a news release, there's little chance the sky is in any serious danger of falling.
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  #63 (permalink)  
Old Thu Mar 04, 2010, 11:40am
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Originally Posted by ajmc View Post
Ed, from where do you get the notion that anyone has a rational expectation of, "Officials becoming the primary examiner of player condition". Sorry, but even if you stay at a Holiday Inn Express, you have to finish medical school and/or be certified at some clinical level to assume those responsibilities.

Anyone assuming you are somehow automatically qualified to render accurate diagnosis is a complete fool, including any attorney who wants to hold you responsible for being something you have never claimed to be, or there is no reasonable expectation that you automatically are. As previously suggested, the irrational fear of what some bogeyman attorney "might" do, creates little but unnecessary paralisys.

Forgive me, but it shouldn't take you longer than 30 seconds to, "be cognizant of the signs of concussion", which is a whole lot different from diagnosing potential concussion. You are not a doctor, stop trying to convince yourself anyone will ever presume you are an "appropriate health-care professional".

With all due respect to, and appreciation for, Mayoclinic.com, their list of concussion symptoms, in situations, where they are being displayed at an obviously problematic level, are and have long been, worthy of sending a player off for evaluation, regardless of what might actually prove to be causing them.

The point being missed may simply be that you are getting way, way ahead of yourself conjuring up all sorts of exaggerations that that will likely never, ever be part of any (actual) expectation or rule. If some of your wildest concerns do make it to the final rule wording, they will have to be addressed and dealth with, but as of now, based on a news release, there's little chance the sky is in any serious danger of falling.
Al, understand you read the dictionary, however, look up the second definition of "primary" that means the first in a series. By that I mean the official becomes the first to note the symptoms as opposed to "primary" meaning the highest rank which would be the doctor only after suspected identifcation by the official. And, I hate Holiday Inn Express.

To the point and I would like to see your answer, in short form please.

A player vomits. You send him off for evaluation. Do you restrict him from competition because he displayed a sign of concussion?
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  #64 (permalink)  
Old Thu Mar 04, 2010, 12:26pm
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Originally Posted by Ed Hickland View Post
Al, understand you read the dictionary, however, look up the second definition of "primary" that means the first in a series. By that I mean the official becomes the first to note the symptoms as opposed to "primary" meaning the highest rank which would be the doctor only after suspected identifcation by the official. And, I hate Holiday Inn Express.

To the point and I would like to see your answer, in short form please.

A player vomits. You send him off for evaluation. Do you restrict him from competition because he displayed a sign of concussion?
As briefly as possible Ed, for years I've assessed that a player vomiting on the field, had some sort of medical issue that common sense guided me to invoke NF: 3-5-10-a (in it's current format) and turn him over to someone in a better position to evaluate and determine if what caused him to vomit was a threat to his ability to continue playing.

I'm under the impression a whole raft of things can cause a player to vomit, and none of them are good. I'm also absolutely convinced I'm nowhere near competent to diagnose what might specifically be causing that reaction and trust the resources, normally available, are in a far better position to determine cause and decide if that player is fit to continue.

Just for the record, if he were to comeback in a play later and barf again (before, during or after) the next play, I'm going to send him back out for additional assessment.
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  #65 (permalink)  
Old Thu Mar 04, 2010, 01:08pm
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Originally Posted by ajmc View Post
As briefly as possible Ed, for years I've assessed that a player vomiting on the field, had some sort of medical issue that common sense guided me to invoke NF: 3-5-10-a (in it's current format) and turn him over to someone in a better position to evaluate and determine if what caused him to vomit was a threat to his ability to continue playing.

I'm under the impression a whole raft of things can cause a player to vomit, and none of them are good. I'm also absolutely convinced I'm nowhere near competent to diagnose what might specifically be causing that reaction and trust the resources, normally available, are in a far better position to determine cause and decide if that player is fit to continue.

Just for the record, if he were to comeback in a play later and barf again (before, during or after) the next play, I'm going to send him back out for additional assessment.
You did not answer the question posed?

Let me restate and add some clarity. Player vomits. This is one of the signs of a concussion. It is a lower level game with no medical personnel immediately available. Do you sit him?
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  #66 (permalink)  
Old Thu Mar 04, 2010, 01:17pm
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Originally Posted by Ed Hickland View Post
You did not answer the question posed?

Let me restate and add some clarity. Player vomits. This is one of the signs of a concussion. It is a lower level game with no medical personnel immediately available. Do you sit him?
What kind of a stupid question is this? Has the number, location, or skill of the training staff ever had anything to do with sending someone out of the game?
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  #67 (permalink)  
Old Thu Mar 04, 2010, 01:46pm
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Originally Posted by Cobra View Post
What kind of a stupid question is this? Has the number, location, or skill of the training staff ever had anything to do with sending someone out of the game?
You may think it is stupid but take ajmc's answer. You don't have medical personnel to rely on a many lower level games, in fact, sending a player out in circumstances where medical personnel are absent relies on a coach's evaluation and he may be more ignorant of concussion symptoms than the officials. Now NFHS shifts the onus for concussion evaluation upon officials. Coach goes he's ok, putting him back in the game.

Later than evening he is rushed to the ER and diagnosed with a severe concussion.

Now tell me that question is stupid! It is reality!
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  #68 (permalink)  
Old Thu Mar 04, 2010, 01:49pm
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Quote:
Originally Posted by Ed Hickland View Post
You did not answer the question posed?

Let me restate and add some clarity. Player vomits. This is one of the signs of a concussion. It is a lower level game with no medical personnel immediately available. Do you sit him?
Of course I answered your question. You didn't like the answer so you added additional qualifications to try and frame am answer the way you want the answer to look. If you want to answer your question, go ahead and answer it, don't waste my time with really stupid "yea, but" nonsense to try and get a different answer from me.

If you'd like to take your question even further, allow me to provide the answer you appear to be searching for. If I'm dealing with, what might be considered inappropriate or inadequate health-care professionals, whose decisions I was not comfortable with, I'm confident I could bring sufficient interpersonal skills into play so as to persuade, those whose decision I may be uncomfortable with, to accept my point of view which would ALWAYS favor the side of player safety and caution.

If you require written authorization before feeling comfortable enough to respond to your own common sense, you might find solace in the second sentence of NF: 1-1-6, "The referee's decisions are final in all matters pertaining to the game.". Of course that requires you be comfortable with and ready to accept any consequences related to your decisions.

You seem to be laboring under the illusion this is some kind of vote, it is not. The field official has the unilateral authority to decide when and if a player's condition merits further evaluation, and turns him over to sideline administrative personnel to conduct appropriate evaluation. The sideline has unilateral authority to determine, as well as the unilateral responsibility to provide, an appropriate evaluator who will conduct an appropriate evaluation and determine, without any input or consultation from field officials, whether that player is medically fit to resume play.

Other than really extreme and rare circumstances, such as addresed above, the decisions, of the sideline personnel responsible for making that determination, hold sway.

Last edited by ajmc; Thu Mar 04, 2010 at 01:52pm.
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  #69 (permalink)  
Old Thu Mar 04, 2010, 02:09pm
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Originally Posted by ajmc View Post
Of course I answered your question. You didn't like the answer so you added additional qualifications to try and frame am answer the way you want the answer to look. If you want to answer your question, go ahead and answer it, don't waste my time with really stupid "yea, but" nonsense to try and get a different answer from me.

If you'd like to take your question even further, allow me to provide the answer you appear to be searching for. If I'm dealing with, what might be considered inappropriate or inadequate health-care professionals, whose decisions I was not comfortable with, I'm confident I could bring sufficient interpersonal skills into play so as to persuade, those whose decision I may be uncomfortable with, to accept my point of view which would ALWAYS favor the side of player safety and caution.

If you require written authorization before feeling comfortable enough to respond to your own common sense, you might find solace in the second sentence of NF: 1-1-6, "The referee's decisions are final in all matters pertaining to the game.". Of course that requires you be comfortable with and ready to accept any consequences related to your decisions.

You seem to be laboring under the illusion this is some kind of vote, it is not. The field official has the unilateral authority to decide when and if a player's condition merits further evaluation, and turns him over to sideline administrative personnel to conduct appropriate evaluation. The sideline has unilateral authority to determine, as well as the unilateral responsibility to provide, an appropriate evaluator who will conduct an appropriate evaluation and determine, without any input or consultation from field officials, whether that player is medically fit to resume play.

Other than really extreme and rare circumstances, such as addresed above, the decisions, of the sideline personnel responsible for making that determination, hold sway.
Al, I'm not looking for a set answer, I am asking for consideration of various circumstances we may encounter. The rule is there, we must deal with it the same as officials in all the other sports. There were obvious assumptions made at the NFHS and Rules Committee levels and many have expressed concern over implemenation for good reason. I'm intelligent and objective enough to listen to others without judgment as I would expect the same consideration. Just like when I'm in the classroom and tell the students who happen to be adult there is no such thing as a stupid question because you have enough knowledge to know this might happen. And, from experience we all know the Rules Committees seek feedback and often act upon the feedback they consider appropriate.

You may think you have all the answers but as expressed earlier in this thread others see problems and anyone who seeks to stifle honest thought really needs to seek life in a republic where dissenters are quieted at the muzzle end of a gun. Luckily we live where thought is valuable. Where thought produces progress and resolves problems. Thanks Comrade.
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  #70 (permalink)  
Old Thu Mar 04, 2010, 03:24pm
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Originally Posted by Ed Hickland View Post

You may think you have all the answers but as expressed earlier in this thread others see problems and anyone who seeks to stifle honest thought really needs to seek life in a republic where dissenters are quieted at the muzzle end of a gun. Luckily we live where thought is valuable. Where thought produces progress and resolves problems. Thanks Comrade.
Ed, when you set a confrontational tone in asking questions, you shouldn't be surprised if the answers given match your tone. You're entitled to make whatever assumptions you like, but that doesn't mean that those assumptions are probable enough to construct, or impact, procedures or rules.

Your concern seems to be about a level of responsibilities that current rules nor the suggested revisions suggest.
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  #71 (permalink)  
Old Thu Mar 04, 2010, 04:58pm
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Originally Posted by ajmc View Post
Ed, when you set a confrontational tone in asking questions, you shouldn't be surprised if the answers given match your tone. You're entitled to make whatever assumptions you like, but that doesn't mean that those assumptions are probable enough to construct, or impact, procedures or rules.

Your concern seems to be about a level of responsibilities that current rules nor the suggested revisions suggest.
You have told everyone that they are crazy for having concerns and you are talking about the tone that Ed has to ask a basic and realistic question?

I am sorry, there is nothing you are going to say here that is going to change my mind. As of right now, the issues that this raises has me concerned as well as others. You can say that we know how to diagnose these things, I clearly feel I cannot. And Ed raised a very good issue. I have seen players vomit in games and I never once thought it was a possibility of a concussion. Now since that is a possibility, you will have inconsistent applications as most people that officiate football will not read this thread and will not know that is even a sign or symptom. At best that is a visible sign where the other things listed are subjective at best from a far.

At the end of the day, I do not have to work with you or others. So this is really not necessary to keep debating this issue. I will wait until my state comes out with clearer information and ask questions when I am not sure what the policy is.

Peace
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  #72 (permalink)  
Old Thu Mar 04, 2010, 05:41pm
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Originally Posted by JRutledge View Post
You have told everyone that they are crazy for having concerns and you are talking about the tone that Ed has to ask a basic and realistic question?

I am sorry, there is nothing you are going to say here that is going to change my mind. As of right now, the issues that this raises has me concerned as well as others. You can say that we know how to diagnose these things, I clearly feel I cannot. And Ed raised a very good issue. I have seen players vomit in games and I never once thought it was a possibility of a concussion. Now since that is a possibility, you will have inconsistent applications as most people that officiate football will not read this thread and will not know that is even a sign or symptom. At best that is a visible sign where the other things listed are subjective at best from a far.

At the end of the day, I do not have to work with you or others. So this is really not necessary to keep debating this issue. I will wait until my state comes out with clearer information and ask questions when I am not sure what the policy is.Peace
I don't think I suggested anyone is crazy, but the extent of some of the concerns raised are simply not supported by the information that's been released and seem somewhat exaggerated. I DO NOT think game officials are competent to "diagnose concussions" and have suggested that anyone who thinks they are, is absolutely wrong.

I have seen any number of players vomit during games, and the issue of concussion has never entered my mind, but I have always sent those players to their sideline to be assessed as to why they threw up, because I do believe throwing up is an obvious sign that something is wrong.

The same has been true if I saw a player who a appeared dizzy, out of balance, incoherent or non-responsive. I've never had a player complain of headaches, and would have no way of otherwise knowing if he didn't complain, but if a player does complain of headache, I would send him out for assessment. None of that has anything to do with my diagnosing anything, I'm not a doctor and nobody has any logical reason to think, or even imagine, that I'm qualified to diagnose anything.

Since I make no claim to be competent to make a medical diagnosis, have never suggested I am competent to do so and there has never been any indication made that I am, or should be expected to be competent in making a diagnosis of concussion, how can I be held responsible for failing to make such a diagnosis?
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  #73 (permalink)  
Old Thu Mar 04, 2010, 09:31pm
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Originally Posted by ajmc View Post
I don't think I suggested anyone is crazy, but the extent of some of the concerns raised are simply not supported by the information that's been released and seem somewhat exaggerated. I DO NOT think game officials are competent to "diagnose concussions" and have suggested that anyone who thinks they are, is absolutely wrong.

I have seen any number of players vomit during games, and the issue of concussion has never entered my mind, but I have always sent those players to their sideline to be assessed as to why they threw up, because I do believe throwing up is an obvious sign that something is wrong.
Having a concussion as opposed to having heat stroke or being dehydrated or two complete different situations and set of circumstances and require different documentation now. And if you do not understand that distinction and why that is a concern, well I really do not know what to tell you.

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The same has been true if I saw a player who a appeared dizzy, out of balance, incoherent or non-responsive. I've never had a player complain of headaches, and would have no way of otherwise knowing if he didn't complain, but if a player does complain of headache, I would send him out for assessment. None of that has anything to do with my diagnosing anything, I'm not a doctor and nobody has any logical reason to think, or even imagine, that I'm qualified to diagnose anything.
I can see dizzy and out of balance a little, but again those could be for other medical issues. Those are not just automatically because of a concussion.

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Originally Posted by ajmc View Post
Since I make no claim to be competent to make a medical diagnosis, have never suggested I am competent to do so and there has never been any indication made that I am, or should be expected to be competent in making a diagnosis of concussion, how can I be held responsible for failing to make such a diagnosis?
Easily, if you think one is for dehydration and it is really a concussion. You let the player come back in thinking they had an issue that was not related to a concussion and someone puts them back into the game. Someone just might say "you" were negligent and did not do your job. Or if you allowed a player to come back in the game because a trainer told you they were OK (if the rule is not specifically defined). Someone can and will say you were not doing your job and when they find out that the concussion helped result in something serious (and they can lead to death); you might be one of the many people they come looking for to pay for someone's loss. That in my opinion should not be the role of an official, especially those that are not doctors or nurses or even athletic trainers by trade.

No one is saying we are concerned that we will not send off a player. We are concerned that we might think a players is hurt for another reason and then found out they had a concussion. Or even better, we send a player off for what we believe to be a concussion, then it clearly is not after a thorough examination and we somehow get blamed for it being the wrong player and something affecting the outcome. Sorry, I see a lot of problems with this language. It is one thing to send a player off for a play or two, it is quite another to diagnose an injury that may or may not be present.

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Old Fri Mar 05, 2010, 09:55am
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Having a concussion as opposed to having heat stroke or being dehydrated or two complete different situations and set of circumstances and require different documentation now. And if you do not understand that distinction and why that is a concern, well I really do not know what to tell you.



I can see dizzy and out of balance a little, but again those could be for other medical issues. Those are not just automatically because of a concussion.



Easily, if you think one is for dehydration and it is really a concussion. You let the player come back in thinking they had an issue that was not related to a concussion and someone puts them back into the game. Someone just might say "you" were negligent and did not do your job. Or if you allowed a player to come back in the game because a trainer told you they were OK (if the rule is not specifically defined). Someone can and will say you were not doing your job and when they find out that the concussion helped result in something serious (and they can lead to death); you might be one of the many people they come looking for to pay for someone's loss. That in my opinion should not be the role of an official, especially those that are not doctors or nurses or even athletic trainers by trade.

No one is saying we are concerned that we will not send off a player. We are concerned that we might think a players is hurt for another reason and then found out they had a concussion. Or even better, we send a player off for what we believe to be a concussion, then it clearly is not after a thorough examination and we somehow get blamed for it being the wrong player and something affecting the outcome. Sorry, I see a lot of problems with this language. It is one thing to send a player off for a play or two, it is quite another to diagnose an injury that may or may not be present.

Peace
Now you're just being silly. All this nonsense about whether you send a player off because you suspect a potential concussion, rather than a heatstroke is a bright red herring. The simple fact is YOU sent him off because YOU sensed he MAY not be fit to continue for WHATEVER reason, is what counts.

Specifically why you sent him off doesn't matter. THAT you sent him off is what counts, from that point on it's the sole responsibility of the team's designated, "appropriate health-care professional" to determine if there's a problem, what that problem might actually be and to evaluate his fitness to continue participating and determine whether or not he reenters the game.

If they determine there's no problem, wonderful, he comes back in one play later and life goes on. Clearly and appropriately, the Gods of football have decreed this is an area we should err on the side of caution, which when you consider the grand scheme of things that matter, makes a lot of sense. How we may respond to, or even care about, comments regarding whether the outcome of the game might have been affected by your choosing to verify a players personal safety, is entirely up to the individual. Personally, I don't recommend spending a lot of time on it.

Some fool, actually any fool, can say anything fools are inclined to say. Whatever they choose to say really doesn't matter, unless and until YOU choose to pay attention to them. If we choose to fixate on the possibilities of what fools might conjure up as possible problems, we can find all sorts of "problems" in any rule language seeking verbiage that will cover the full imagination of fools, and never reach total protection.

As long as we acknowledge we're not doctors, make no claim to being an "appropriate health-care professional (as associated with our function on the field during a game) or claim or offer medical expertise or attempt to project a diagnosis, we bear no responsibility for medical judgments made, or not made, based on our job performance as game officials.

If you want to get yourself all worked up about, what at this point is absolute and pure speculation and imagination, that's up to you and on you. I'm comfortable waiting until the written rule is published, which I anticipate will include a rational caution to be attentive to the issue of concussion, which has been identified as a problem area.
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Old Fri Mar 05, 2010, 10:14am
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Al,

There are people literally on the National Federation Forum that have been discussing this rule. You are the only person that seems to think that there is not a problem. And there are people that have identified themselves as people in the medical profession (several have) and they feel uncomfortable with the way this rule is written because they realize you need more examination and training to determine a real concussion. Now if you do not want to accept that, this is fine with me. I have concerns and will continue to until they change the rules or the language to not have me concerned.

Life will go on.

Peace
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