Sideline Consult

So You Want to Be a High School Football Team Doctor

Bert R. Mandelbaum, MD, DHL (Hon)


September 28, 2016

A Question of Medical Judgment

Don't let the game affect your judgment. When it comes to concussions, the threshold is the threshold, regardless of the score and the ticking clock. This game may be for the state championship. It may be the biggest game in the life of a player or the career of a coach. None of that can affect your decision about whether to let the athlete back in the game.

For concussions, clear protocols are available, such as the guidelines of the American College of Sports Medicine.[14] For other types of injury, you may need to rely more on your own judgment, but you'll need the same fortitude in the face of pressure from coaches and players who put winning ahead of health. That's one of the biggest challenges we face: making a sound judgment and not getting caught up in the frenzy of the game.

But you do have to follow the game closely. You can't just be the guy waving to his friends in the stands. Your decisions about return to play may depend on seeing how injuries take place.

If you have access to video replay, that can help you make these critical decisions. I'll never forget the day I was working the US Men's National Team play Brazil in the 1994 FIFA World Cup. When Tab Ramos, famed midfielder for the US team, took an elbow to the head, trainers whisked him back to the locker room. On my way to meet him there, I caught a replay of the injury on a monitor and immediately noticed the telltale signs of decerebrate rigidity. I said, "Sorry Tab, you need to go to the hospital." Sure enough, he had suffered a head fracture and a hematoma.

By analyzing videos of anterior cruciate ligament injuries in American football, my colleagues and I have been able to determine that 68% of these injuries occurred without contact.[15] This has implications for both prevention and treatment. If you look at the video, you can see where the forces are.

When halftime comes, work with the trainer to take a survey of the team. Who is injured? Who needs first aid? Who can return to play and who should not?

After the game, do an even more thorough assessment of the carnage and develop a plan of action for each injury. Who needs to go to the emergency department? Who needs x-rays the next day? Who needs to be casted or splinted?

Take stock of what went well and what you could do better the next time. Go home. Get some rest. You'll need it for the next game.


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