Suspecting the Unexpected

Dustin’s post “Nightmare on a Football Field” inspired me to write this next post.

During the summer of 2010, I was an intern at the University of Wisconsin-Whitewater.  As interns, we worked with the certified staff members at the University to provide health care for all of the camps run through the Continuing Education Department at UWW, whether it was a sports camp, a music camp, or an academic camp.  One of the first camps that we had at UWW this summer was a football camp.  It was a “Perimeter Camp” which included quarterbacks, receivers, defensive backs, linebackers, etc., basically anybody but the linemen.  This camp had over 320 campers that were all out on the practice fields wearing helmets and shoulder pads.  I was the health care provider for all of them, by myself.  I had help inside, but on the field it was all me providing first aid.

On the second day of camp, I am doing some normal triage of injuries, blood, and hydration when one of the coaches brings a kid over on the golf cart.  This kid was complaining of an upset stomach and being light headed.  Since I was busy, I suggested he get some water and relax for a few minutes, lunch was only a couple of hours earlier and for the Wisconsin kids it was hot out (about 75 degrees).  When I went to talk to him a few minutes later, he was sitting in the shade, but he was not feeling better, nor did he look right, I had a hunch immediately that he probably was not suffering from dehydration.  Of course he denied any mechanism of injury that would have alluded to a concussion so I stuck with dehydration thesis while I talked to him.  After a couple of minutes, I knew it was not dehydration and I began asking more concussion-related questions, he finally told me that he and another player had hit helmet-to-helmet during a drill.

At this point, I initiated the sideline concussion assessment in greater detail including a lot of memory stuff, which he was fine with, and pupil activity, which he also was fine with.  His only complaints were having a headache and being dizzy.  At this point I had also asked about any spinal cord involvement including numbness, tingling, or weakness which he denied.  I suggested he get another drink and that’s when things began to get worse.  He was having photophobia (irritation by light) although we were in the shade, balance issues, and he just looked out of it. He now began to complain about weakness in the extremities and pain with extending his neck.

I was skilled and educated to manage a concussion, however, I did not have the clinical background to manage a concussion with deteriorating signs and symptoms, I was still a student and this was a new adventure for me.  So I called into the athletic training room to advise the supervising athletic trainer about the situation and he instructed me to lay the patient down and stabilize c-spine until he could get out to the field.  The adrenaline starts pumping for me, but I had to remain calm.  Talking to the athlete while providing spinal motion restriction for an extended period of time was hard, because he wanted to move and he did not want to answer questions.  When the certified athletic trainer got out there, he quickly assesses the situation and called for EMS.  With the symptoms having lasted for approximately 15-20 minutes and appearing to get worse as well as having some apparent neurological deficits it was warranted to take precautions.  Once the ambulance arrived, we began to prepare him for spinal immobilization.  Thankfully, we did not have football equipment to deal with as he had removed all of it prior to reporting any issues.  The cervical collar was applied and an EMT took over c-spine stabilization before they proceeded to immobilize the entire body.

This story has a good ending—the athlete had a “mild” concussion (as if), but no serious neck injury was found.  For me, it was a big boost of confidence knowing that I had the ability to handle emergency situations.  While my adrenaline was pumping, I never panicked, it was definitely something that I learned from. I truly believe this event went a long way in showing the coaches that I was working with that I did know what I was doing, by managing the situation appropriately, and they appeared to have a greater respect for my abilities and my job the rest of the summer.

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