Last night we had our second girls basketball contest of the winter season and it was a VERY, VERY busy night!!! First, some back story on my experience with girls basketball as an athletic trainer…
This sport is extremely physical. In all my years covering girls high school basketball (11), I’ve observed there are more bodies on the floor and bumps and bruises than any other winter sport, wrestling included. I have no idea why it is like that, but this sport lends itself to a high rate of concussions. In fact, I had four last year, which equals what we had in football this year. I also have been dealing with an athlete that sustained a concussion last January, still has symptoms and has yet to return, which is my second such long-term concussion issue in four years.
Back to last night, we (my A.T. student, two high school observers and I) were going through the routine of the JV game when a previously-concussed athlete that had been cleared by a physician (AGAINST MY ADVICE) was warming up for the second half, and a ball hit her head. Most individuals that get hit in the head by a ball would just get mad and brush it off, but not this one. She crumpled to the floor, dazed and upset. We took her to the training room for evaluation, and she would not return (we will get back to her later).
While my students were observing her in the dark training room, I was back on the floor covering the game, when no more than 5 minutes later a player was dribbling up the court and was tripped and her head bounced off the court. She grabbed her head and was writhing in pain. I got to her side and she had tears in her eyes and a dazed look. After calming her down, she reported just a small headache while sitting on the court, but she was not acting like herself. We stood her up and like a cornstalk in the wind, she wobbled back and forth. She was ushered to the dark training room for observation as well.
By this time our resources were strapped. Good thing I had student observers, as they were put in charge of watching them, (as you could guess, these high school students are well versed in concussions, and working with me they get daily homework about this injury) and if they changed demeanor they would contact me or my college student. We were not in the training room because of paperwork, finding parents, or covering the game still going on. Then chaos knocked on the door.
The phone rang, and it’s from a parent at the junior high just across the parking lot, and he reports a girl on the floor with a head injury (you can see our community is becoming so VERY responsive to this issue). The player was from the visiting team and had not requested an athletic trainer, but the parent KNEW I should be there, and away I went. My college student was on her own with a radio to contact me if needed, and was also observing the other two in the training room.
I evaluated the athlete and talked to her father, which was not easy, because their school/district/community does not have the information that ours does, and it was like starting from scratch. The common phrases – “her bell is just rung”, “she will be fine”, “I want her to play”, “she doesn’t need to miss school”, were flowing rapidly, it was like I was talking to a wall. I just kept showing him the paperwork, telling him how our school district handles this injury, and how serious it could be. It took about 30 minutes, but finally either relented and it was decided she was not going to play. Satisfied but uneasy about it, I talked to the coach and went back to my primary duty at the high school.
Time To Dig In
After all the paperwork was finished I found one parent, while the other was on the way in. Again, I was given resistance about the injury with the first parent. He knew what we do for the concussions at our school, but he refused to take her home, and made her stay and watch the game with all the whistles, lights, and horns. With every horn I looked at her and she cringed, while all I could do was shake my head.
The other dad arrived, this of the girl that had previous head injuries (four in the past year) and was hit in the head by a loose ball. When she returned after her last concussion, her doctors note said no restrictions. We ImPACT tested her anyway, and she was not near her baseline. I told her she should not play, but she demanded that her doctor said it was OK, that she had a note, and that her parents were fine with it. As an athletic trainer, I cannot override a doctor note, but there are things we can discuss with the coaching staff to limit playing time for the safety of the athlete. We decided as a staff we were not comfortable with her participating when I was not around, since I don’t cover all the practices, so her playing time was extremely limited by the coach.
Hardest Part Of The Job
After her injury last night, I had a quick meeting with the AD, who knows of all situations with concussions in the school (part of our process), and told him that I would like to disqualify her from sports until further notice, but needed support form him and the principal if the parents resisted. He strongly agreed and said it is too dangerous for her to be out there, and that they would back me to the fullest, if necessary.
Quick digression here about athletic training….as an athletic trainer I cannot diagnose injuries, and as stated above I cannot override an MD note about participation. But what I can do is MY JOB in protecting athletes from injury. This situation falls under the “for the best interest of the athlete” ethical clause that I like to think all athletic trainers use in times of need.
I begin the discussion with her father and tell him about our concerns due to the previous head injuries. I give him the information pamphlet that he should have received the last time. This info was new to him, and as I looked at the girl, I realized that she did not communicate with him about the previous concussion, other than they needed a doctor’s clearance to play again. He had some great questions like “Why will a doctor will release her and you won’t?” and “Why were all the tests negative?”. After addressing those questions, and discussing the possible impact of this injury later in life and in school, I could feel the wall come down. I could also now feel a father extremely concerned and unaware of all the ramifications that concussions present.
That is when I told both of them that she will no longer be allowed to participate in sports or PE until further notice. It could be one week, one month, one year, or longer. And to return to sports they will have to consult a physician that deals with concussions on a regular basis. I was expecting a defense, even a demand to talk to the AD, but it did not come. Rather I was given…
“Thank you… Thank you for what you do, I appreciate you looking after my daughter,” a firm hand shake, and genuine feeling of relief.