Sideline Consult

So You Want to Be a High School Football Team Doctor

Bert R. Mandelbaum, MD, DHL (Hon)

Disclosures

September 28, 2016

A Team Physician's Challenges

So you just got tapped to be team physician for the local high school. Congratulations! It's an important role, one that gives you a lot of visibility in the community. But it's a big job, too. You'll learn a lot from the hard knocks—real and metaphorical.

Before I say anything more, let's discuss what makes football great. The fitness demanded of this sport will give players a solid foundation for the rest of their lives. And there is something about this sport that creates team spirit. Maybe it's the roughness of it, the shared pain and hard-won triumphs, that forges camaraderie. Like any sport, it raises self-esteem[1] and increases the participants' chances of going to college.[2]

But there are also reasons why fewer kids are participating in American football these days. Chief among them may be new awareness of the injury risk, especially concussions.[3] I worry that some schools have so few players that they are only able to mount one team playing both offense and defense. This seems likely to increase the risk for injury.

We know from studies on professional football players that these injuries can do long-term damage. In addition to cognitive impairment,[4] National Football League (NFL) players suffer from high rates of arthritis,[5] pituitary dysfunction, and bankruptcy[6] compared with the general population.

How can you make sure the players in your charge enjoy the maximum benefits and the minimum harm from their sport? It's not enough to show up at the start of the game and wait on the sidelines for someone to get hurt. Think of yourself as the chief medical officer, in charge of the effects of the game on the players' health. Control all the variables you can, and you'll have the best chance of managing the ones you can't.

In the NFL, there are probably 15 doctors on the sideline from a variety of specialties. As a physician for a high school team, you have to assume all of those roles. That means you have to prepare not only for orthopedic injuries and concussions but also for hyperthermia and hypothermia, sudden cardiac death, and doping.

A Checklist of Responsibilities

Months before the first kickoff, make sure every player gets a precompetition medical assessment. Take a look at the player's general health. Administer a psychoneurologic test[7] to get a baseline before the season starts, so you can make a comparison if a player suffers a head injury. If possible, obtain both an electrocardiogram and an echocardiogram[8] for each player, keeping an eye out for genetic cardiovascular diseases, such as Marfan syndrome.[9] Identify players with such conditions as sickle cell anemia, which increases vulnerability to dehydration and extremes of temperature.[10]

Ask about past injuries and treatments. Get the details of symptoms, procedures, and decisions about return to play. Who has torn a hamstring? Whose shoulder is unstable? Who has undergone surgery?

Although it's designed for soccer, the Fédération Internationale de Football Association (FIFA) standardized precompetition medical assessment form[11] works well not just for soccer, but also for American football. It assigns a risk on a scale from 0 to 5, where 3 is about the midpoint. Above that, rehabilitation needs to be done. The American Orthopaedic Society for Sports Medicine (AOSSM) includes guidance in its athletic health handbook.[12]

After these assessments, turn your eye to team practices. Work with coaches and trainers on fitness regimens. Neck strengthening can reduce the risk for concussions,[12] and a program such as the FIFA 11+[13] can reduce the risk for lower-extremity injuries.

Make sure that practices take place in a healthy environment. Let's say the temperature is going to be 84°F on a given day. You can suggest practicing at 7 AM instead of 9 AM. Discuss with the coach protocols around contact during practices; many teams and leagues have chosen to limit unnecessary tackling and to practice with the head up.[12]

Next, check that you have the right equipment in place. Review what's in your medical kit. You might use a checklist like the one in the AOSSM handbook.[12]

But remember that the equipment for one day may not be ideal for another. If it's a hot day, the team may need extra fluids, electrolytes, and towels in ice buckets. If it's a cold day, make sure bench warmers can warm themselves as well.

High on your list should be an automated external defibrillator. Check that it's on the field at the start of every practice and every game. Determine the best access for emergency vehicles.

Work with trainers and coaches to rehearse emergencies. For example, if athletes have neck problems on the field, you may need to immobilize them.[13] Schedule a day—ideally before the season starts —when the paramedics can come over and practice this with you and other team staffers until you get it right.

For these injuries, your kit should include a backboard. It should also include the same sideline psychoneurologic test you used to get a baseline reading on all your players. If you're dealing with concussions during the game, nowadays you must have a very low threshold for making a diagnosis of concussion.

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