Moral and Legal Crossroads

I recently came across this article written for the Boston Herald website regarding high school sports and athletic trainers. In the article, a local Massachusetts high school athletic director claims that during a women's basketball game, an "overzealous" athletic trainer from the opposing high school purposely removed an athlete for a "possible concussion". The athletic director's claim goes on to suggest that the athletic trainer in question acted in a manner consistent with intent to sabotage the school's chances of advancing to post-season competition. The accusing athletic director went so far as to write letters to the MIAA (Massachusetts Interscholastic Athletics Association) and Boston City League addressing concerns surrounding the athletic trainer's decision to withhold the athlete from competition.

As an athletic training student, I am acutely aware of the professional concerns surrounding ethics, morality, and legality, as they pertain to most levels of athletic competition. The key word here is competition. As athletic trainers and clinicians, we hold ourselves to a high standard of providing care that is ethical, that is moral, and most importantly, that is legal. While the details of this circumstance are not entirely clear, it is common practice in this field to handle potential concussions sensitively and conservatively. Especially in a high school population. As mentioned in previous posts and via information that has been brought to light by many experts, the youth brain is still undergoing critical physical and cognitive development. To subject this forming brain to mild trauma, and still yet risk further damage by not acting conservatively, we are setting children and young adults up for a lifetime of physical and emotional detriments. Making return to play decisions during crucial games is difficult. Like I said, the key word is competition. Teams are physically fighting for the right to be called champions. So naturally, when a decision is made that could influence the outcome of the competition, someone is held responsible and there is generally some polarizing opinions as to how the situation was handled. That being said, the individual (who I do not know personally and cannot attest to professionalism or morality) that made this critical decision was an athletic trainer. An athletic trainer who is keenly aware of the signs and symptoms of concussions, and who is trained not only didactically, but also clinically, to make the proper decisions. An athletic trainer who took an oath to do no harm and practice by a professional Code of Ethics. Why, then, is there such outrage for a decision that was not only necessary, but made by a qualified, trained medical professional?

As it turned out, the athlete was taken to the hospital and had a concussion ruled out by physicians. However, we know in the field of athletic training that concussions are not observable on medical imaging, and are often difficult to diagnose given the overlap of signs and symptoms with many other conditions. Perhaps the outrage stems from the diagnosis of a corneal abrasion (and not a concussion). Regardless, the athletic trainer acted within the professional scope by administering concussion testing, gathering a history where the mechanism of injury could be indicative of a concussion, and making a conservative decision for the benefit and long-term well-being of the injured athlete. Had this athlete been diagnosed with a concussion by physicians, would there still be such outrage over how the athletic trainer responded? Are we no longer to be conservative for the health and well-being of our youth athletes? Without knowing the athletic trainer in question and operating solely off the information provided in the article, my inclination would be to stand by the clinical decisions made by this individual. If a there is a valid mechanism, positive tests, and no clear differential diagnosis, then one must act on what they know, within their scope, in an ethical, moral, and legal manner.

Interestingly, there was a follow-up article regarding the response of the MIAA and Boston City League to the accusing athletic director's letter. In it, the spokesman of the MIAA is quoted as saying: "We're not about to question the judgment of a qualified trainer on the scene at the time... As far as we are concerned, the game is over." The article can be found here.

“We’re not about to question the judgment of a qualified trainer on the scene at the time,” Wetzel said. “As far as we are concerned, the game is over.” - See more at: http://bostonherald.com/sports/high_school/2013/03/new_mission_flap_over_bad_concussion_call_wins_no_sympathy_from_miaa#sthash.XgU4pZ3S.dpuf

“We’re not about to question the judgment of a qualified trainer on the scene at the time,” Wetzel said. “As far as we are concerned, the game is over.” - See more at: http://bostonherald.com/sports/high_school/2013/03/new_mission_flap_over_bad_concussion_call_wins_no_sympathy_from_miaa#sthash.XgU4pZ3S.dpuf

“We’re not about to question the judgment of a qualified trainer on the scene at the time,” Wetzel said. “As far as we are concerned, the game is over.” - See more at: http://bostonherald.com/sports/high_school/2013/03/new_mission_flap_over_bad_concussion_call_wins_no_sympathy_from_miaa#sthash.XgU4pZ3S.dpuf