It. Has. To. Stop. (revisited)

Dustin.Fink Dustin Fink

This is one of my more outspoken and shared opinion pieces about concussions, it originally was penned in August of 2013.

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There is a lot of belief and trust each and every one of us has in those that are medical professionals.  The further you go up the chain in those professionals our trust is greater and our belief is stronger that they know more.  The sad fact that in some instances those near or at the top of the chain don’t know enough and are putting people, in this case a kid, in danger; not only in the near future but the long-term.

Compared to a physician (MD/DO) I would say my medical skills are pale in comparison, and rightfully so; their schooling and experience far outpace what I have learned in the medical field.  Because of this the athletic trainer (I) am not held as in high regard when it comes to decisions about the care of an athlete; which I am fine with… 97.43% of the time (I just made up that number, ha).  However there are times when a MD/DO – those making the final and binding (in parents and patients minds) decisions – make a mistake.  This is not just some Monday morning quarterbacking either, its FACT.

Just recently I had an athlete take a blow to the body and head in a practice, and they immediately came to me distressed.  How distressed?  Well that is one advantage I have over a MD/DO, especially the ER doc, I know the kids and have the resources of his/her peers as well as coaches who have known the kid for many years.  In this case the athlete was way out of their sorts;

  • stumbling
  • grabbing eyes
  • rubbing head
  • slow speech

Upon asking questions to this athlete they expressed their history with head injuries and told me their head felt like the three previous concussions they had experienced, except that they had never been this “‘wobbly’” in before.

After letting the player calm down and get  a drink a quick sideline examination/test confirmed what I suspected; possible concussion.  Unfortunately the family has dealt with this situation many times, so the “drill” was known and the information I was passing along was nothing new.

Upon arrival of the athletes caregiver we decided the state of the individual along with the history warranted a visit to the ER to calm any concerns of more extensive damage.  So off they went, with the hopes of nothing more than a concussion; while I was pleased that the caregivers “got it”.

Later in the evening I received a phone call from the parent and was told this; “The doctor says they don’t have a concussion, a strained neck, and they can return to play and follow-up with their PCP.”  I asked why they thought it was not a concussion and they were told “there was nothing on imaging that would indicate a concussion.”

OMG, SMH, AYFKM, WTH, insert your own acronym.

This exact situation is the bane of our existence as athletic trainers when it comes to concussions – a close second is the ER doc telling an athlete they are out for 2 weeks with a sprained ankle – people who are seeking medical care listen most importantly to the doctors in this situation.  Not only does it make me look bad and uninformed, but that information is taken gospel, regardless of my well thought out dissertation/presentation about the suspected injury.

I get it, that I cannot diagnose and I’m not a doctor, but as we have educated hundred of thousands of people it doesn’t take a doctor to identify a concussion – it takes common sense and understanding the evolution of this injury.  When it comes to concussions I will put up my knowledge against 99% of MD’s and in this case my knowledge trumps what the ER doc has said; and I will not apologize for saying this.

I was told that the athlete told the doc the same stuff he told me about the mechanism of injury, to the immediate symptoms, their history and the symptoms at the hospital.  Yet, to my disdain all of this was ignored for imaging?  When was the last time the attending read any material on closed head injuries or mTBI, let alone concussions.  I would hazard a guess its been since medical school and its @$^ing ridiculous.

This cannot happen.  This should not happen.  This is borderline negligence on the part of the doctor.

What happens if this athlete did not have an athletic trainer and goes right back to action and sustains another blow?  How would a coach look if he sent this player to the ER only to be undercut by the attending?  Does the coach begin to second guess themselves and not send these type of injuries to the ER?  In all those questions it’s a catastrophic outcome, regardless if the worst were to happen, its catastrophic for the long-term brain health of the individual.

Needless to say I placed a phone call to the physician with concussion experience at that hospital and reported it to him.  He was very unhappy, he has spent time trying to educate the emergency department on such cases, but apparently this has fallen on deaf ears.

It. Has. To. Stop.

I am not done with this by a long shot, as soon as this is posted the ED will be getting a phone call from “some athletic trainer” who in their initial estimation will believe I am playing outside my realm of knowledge.  When, not if, I get the chance to talk to the person in charge they will find out I am about the furthest from that when it comes to concussions.