Rulings for Concussed players

[RickKY]

Picked this up from NDHS Forum...

The NFHS Sports Medicine Advisory Committee was very proactive in this rule change. The following are some suggested guidelines for us: PLAY 1- With 2:00 to play in the first quarted, A1 exibited signs of a possible concussion and was sent out of the game by the officials. When the second quarter begins, A1 is sent back into the game. RULING: Legal. If A1 returns, the officials are to assume an appropriate health care professional approved. However, if A1 again shows signs consistent with a concussion, he should be sent off again. PLAY 2:- A1 sustains a hard but legal hit and is slow to get to his feet. When he does rise, he holds his head and has trouble keeping his balance. The officials send A1 off the field. There is no appropriate health care professional on site. A1 is sent back into the game after sitting out one play. RULING: Responsibility for A1's return FALLS ON THE HEAD COACH. The officials are not required to determine if an appropriate health care professional has examined and cleared A1. ---- Feel better now,fellow zebras?

I feel better.

[AlUpstateNY]

I'm pleased these rulings satisfy your concerns.  There's really no difference than what is currently in effect with the "apparently injured" language.  Still worth considering, is that NFHS rules apply to a lot of different "Youth football" organizations who may not be as cognizant of their responsibilities as local HS's. 

What's really happening is a field official becomes concerned, and fulfills his responsibility by acting on that concern and sending the player out to be evaluated by the next level of supervision.  The responsibility becomes theirs, as to determining that the player is fit to return to play.  As the first ruling suggests, regardless of what the off field review suggests, if you are not comfortable with the way the player being sent back in is reacting (it would have to be something pretty obvious and worrysome) you have absolute authority to send him right back out for further assessment.

That is not to suggest you are competent to render or countermand a medical decision, should consider yourself an "appropriate health-care professional (even if you might be in private life), it is simple, basic common sense that as an adult supervisor of a student athlete game, you are not "comfortable" with the actions or behavior of a participant and are referring that player to a more qualified, appropriate review. 

There is absolutely nothing we do, that trumps our basic responsibility of being concerned for player safety as to their medical/physical ability to compete in this activity. We don't have to be right, we have to be attentive and cautious.   

[HLinNC]

Still worth considering, is that NFHS rules apply to a lot of different "Youth football" organizations who may not be as cognizant of their responsibilities as local HS's. 

This brings up a great point Al.  Our local youth league, which isn't particularly known for wanting to hear too much about what we have to say anyway, is going to need to be enlightened as are all youth leagues following NFHS rules.  The most qualified "health care professional" we see at these games are usually rescue squad 1st responders.  There may occasionally be an EMT, of which level only they know what they are. 

Under the scenarios given, we send a kid off, I guess somebody behind me evaluates him and lets the coach know if he's go/no . Unfortunately, most of the coaches greatest talents are yelling "hit somebody!" and quoting half wrong NCAA rules to me.

I foresee some serious rate increases for youth football organization liability insurance.

[bama_stripes]

Alabama has approved the following:

"A student removed from a contest because of signs or symptoms of a concussion may not return to play until a medical release is issued by a medical doctor. This policy is more restrictive than the National Federation rule that allows 'an appropriate health-care professional' to clear an athlete for play."

That takes away a lot of the potential for arguements.

[RickKY]

We're still waiting for KHSAA to report on this.  Current rules for unconscious player to have a doctor's note before returning.  Hopefully the same will apply for concussions.  We'll see.

[Rulesman]

Alabama has approved the following:

"A student removed from a contest because of signs or symptoms of a concussion may not return to play until a medical release is issued by a medical doctor. This policy is more restrictive than the National Federation rule that allows 'an appropriate health-care professional' to clear an athlete for play."

That takes away a lot of the potential for arguements.

...and common sense prevails.

[Livin' in the pit]

Alabama has approved the following:

"A student removed from a contest because of signs or symptoms of a concussion may not return to play until a medical release is issued by a medical doctor. This policy is more restrictive than the National Federation rule that allows 'an appropriate health-care professional' to clear an athlete for play."

That takes away a lot of the potential for arguements.

So a kid barfs on the field.

That's a sign of concussion.
It's also a sign that buddy ate something ugly.
Or has internal injuries.

This is dangerous terrain, folks.

[RickKY]

So a kid barfs on the field.

That's a sign of concussion.
It's also a sign that buddy ate something ugly.
Or has internal injuries.

This is dangerous terrain, folks.

I think it should be relatively easy to determine if vomiting is a result of illness or concussion.  The lack of head contact and other signs of concussion would be telling.

[AlUpstateNY]

So a kid barfs on the field.

That's a sign of concussion.
It's also a sign that buddy ate something ugly.
Or has internal injuries.

This is dangerous terrain, folks.

Only if YOU want it to be dangerous.  If any player "barfs" on the field, I would hope you're going to look at the kid, and see if he's OK.  You do what you thik is right, I've always sent players off, to get looked at, under the "apparently injured" wording of the current rule.  As Don Merideth advised Howard Cossell, who was lambasting Clarrence Hill for taking himself out of a Dallas game for an upset stomach, "When you're wearing white pants in front of a large crowd, it's not a good idea to risk getting hit in the stomach".  

Barfing, is a fairly good sign that something may be wrong (apparently injured), or sick, or dehydrated or a bunch of other things that all point towards NOT being physically ready to participate, or defend himself, in a game of extreme physical contact.  Whether or not there's a problem is NOT our call to make, our job is simply to be alert enough to make sure that player is evaluated by someone on a sideline (who is game management's responsibility to see) who is competent to make a determination for that player being able to continue.

[Atlanta Blue]

I think it should be relatively easy to determine if vomiting is a result of illness or concussion.  The lack of head contact and other signs of concussion would be telling.

Provided you SEE the head contact, or lack thereof.

The officials are never going to see all head contact.  Some of it comes down in a pile, some of it comes with contact with the ground, away from the ball or the flow of the play.

This isn't a complaint, there is no way I would expect the officials to see possible head contact for every player on every play.  Another issue is, signs of a concussion like vomiting often don't manifest themselves right away, but come later.  So a kid gets his head knocked on play 2 of the game, and then throws up 15 minutes later.  Is the vomiting a sign of the concussion?  You as an official don't know, I as a coach don't know, and even a doctor doesn't know.  Vomiting in itself is RARELY going to be seen as a sign of a concussion - it is one indicator among many that together show signs of a concussion.

I have kids that are going to throw up EVERY game, and it has nothing to do with a concussion, it's their nerves.  I have two right now that I would worry about if they DIDN'T throw up before the game.  But the officials aren't going to know this.

Trust the coaches to have some sense in dealing with their players.  By all means, point it out to us, that's fine.  But know that we know them better than anyone else around, possibly better than their parents for these circumstances.

[Livin' in the pit]

I think it should be relatively easy to determine if vomiting is a result of illness or concussion.  The lack of head contact and other signs of concussion would be telling.

Lots of stuff happens in a game. What if the reaction is to a hit five minutes earlier that nobody saw?

[Livin' in the pit]

Barfing, is a fairly good sign that something may be wrong (apparently injured), or sick, or dehydrated or a bunch of other things that all point towards NOT being physically ready to participate, or defend himself, in a game of extreme physical contact.  Whether or not there's a problem is NOT our call to make, our job is simply to be alert enough to make sure that player is evaluated by someone on a sideline (who is game management's responsibility to see) who is competent to make a determination for that player being able to continue.

I think you missed the point. If this new rule is to cover apparent concussions, are we all going to get EMS training? Fuzzy vision is a sign of concussion. It's also a sign that somebody got fingers in the eye.

We're traffic cops, not paramedics.

[AlUpstateNY]

I think you missed the point. If this new rule is to cover apparent concussions, are we all going to get EMS training? Fuzzy vision is a sign of concussion. It's also a sign that somebody got fingers in the eye.

We're traffic cops, not paramedics.

Where do you get the idea about EMS training?  If a player got a finger in his eye, to the point you noticed his reaction and he couldn't see right, are you not sending him to the sideline for someone to evaluate his ability to participate?  Understand, the new rule is NOT "to cover concussions" it's simply to continue the current rule, to keep us alert to "apparently injured players" with additional attention to the area of concussions.

It sounds like you might be the one having trouble finding "the point".

[HLinNC]

The summer edition of NF Official's Quarterly has a two page article.

    "The NFHS Sports Medicine Advisory Committee, ....developed new guidelines for the management of a student exhibiting signs, symptoms, or behaviors consistent with a concussion. These guidelines will go into all NFHS rules books for 2010-11. The language will read: Any athlete who exhibits signs, symptoms, or behaviors consistent with a concussion (such as loss of consciousness, headache, dizziness, confusion, or balance problems) shall be immediately be removed from the contest and shall not return to play until cleared by an appropriate health-care professional."

  "Given that the vast majority of concussed athletes do not lose consciousness yet often show signs, symptoms, and behaviors of concussion, the NFHS SMAC strongly believes that officials must be empowered to remove these athletes from play....... "

  "Neither officials, nor coaches, are expected to "diagnose" a concussion... "

"The ...official is not responsible for the evaluation or management of the participant following their removal ...The responsibility ...falls upon the head coach, appropriate health-care professional or other individual designated by school administrators. If an appropriate health-care professional on site determines that the athlete HAS NOT suffered a concussion, the athlete may return to play. If there is no appropriate health-care professional available to evaluate the athlete...SHOULD NOT be allowed by the coach to return...."

    "The official does not need written permission for an athlete to return to competition nor does the official need to verify the credentials of the approriate health care professional.
    ...compliance is a health and safety issue that is clearly the responsibility of the head coach and school admininistration, NOT the official."

"An appropriate health care professional must be determined by each member state association and/or school district with respect to state laws and local preferences..... and may, depending on controlling law, include MD's, DO's and certified athletic trainers. "

[TampaSteve]

I don't think anyone addressed this regarding barf.
If we have barf out there, we now have have hazardous waste on the field and need it washed off with h20 before we resume play.

[waltjp]

I don't think anyone addressed this regarding barf.
If we have barf out there, we now have have hazardous waste on the field and need it washed off with h20 before we resume play.

Don't be ridiculous, Steve.  Just put some cones around the area and play on.

[Fadamor]

Technically Steve is correct, but realistically all that ever happens it an AT brings out a water bottle and squirts down the spot.  The spot is still a biohazard, but at least the acids have been diluted a bit.

Do you think the ADs would get upset if we started making those barf spots with flourescent orange paint so they know where to disinfect the following morning?