It’s every coach’s worst nightmare.
With time running out in an intense football game, the quarterback drops back and hits his receiver for a first down. The safety comes out of nowhere to deliver a bone-crunching tackle.
A hush falls across the high school stadium as the receiver lays motionless, face down on the hard turf. The coach rushes in from the sideline. With no training to handle such a crisis, he calls 911.
In a perfect world, high school athletes would have access to both team physicians and athletic trainers,
a luxury enjoyed at Hanover County’s Atlee High School thanks to the services of Sally Marks, ATC, and Mike Petrizzi, M.D.
Scenes like this are not uncommon, because less than 20 percent of high schools have a working relationship with a team doctor. And only about 55 percent of high school student athletes have access to a licensed athletic trainer.
“It can be very scary,” says Mike Petrizzi, M.D., clinical professor of family medicine on the MCV Campus. He’s the medical director of Hanover Family Physicians and has been team physician at the county’s Atlee High School since 1991. “I think there are many family doctors and pediatricians who know they are needed on the sidelines, but are insecure about whether they have sufficient training.”
That’s why Petrizzi teamed up with Steve Cole, certified athletic trainer and associate athletic director at the College of William and Mary, to create the Sideline Management Assessment Response Technique (SMART) workshop in 2003. The course teaches physicians the skills necessary to be both competent and confident in their ability to serve the community at athletic events.
“The better trained providers are, the better chance we have of avoiding a catastrophic event on Friday night,” says Jeff Roberts, M’04, program director for the St. Francis Primary Care Sports Medicine Fellowship Program in Richmond.
Roberts, team physician for Virginia’s Powhatan High School, is a SMART instructor. The four-hour course emphasizes hands-on learning, with volunteers in football gear bringing the Friday night experience to life. Participants practice how to recognize and manage football injuries, including concussions, stingers, separated or dislocated joints, torn or sprained ligaments and broken bones. They practice the log roll – moving a player with a suspected neck injury onto a backboard.
“Thankfully, I have never had an athlete suffer a c-spine fracture,” Petrizzi says. “But you never know what you might face. It sure does help to have practiced what to do in the event of a catastrophic injury. Our student athletes deserve the best care.”
As a high school athlete, Petrizzi remembers watching a news program that asked, “who’s watching your kids?” Even then, he was alarmed to discover that first-aid training was not a requirement for coaches.
“I couldn’t believe it,” he says. “It became a passion of mine to develop a program that would help make sports participation safer for our youth. Trained personnel are needed whether the team is having a bad year or a winning year. If something should happen, these athletes need to be with someone they know and trust. That’s important.”
In an ideal world, Petrizzi says, schools would have an athletic trainer and team doctor working together to provide the best care. He is hopeful that SMART one day will be part of family medicine and pediatric residency training across the country and that those completing the course will, in turn, teach others – a vital step in providing more coverage at the high school level.
“Unfortunately, injuries are part of any sport,” Roberts says. “The question is, how prepared are you to handle them?”
By Janet Showalter
• When in doubt, keep them out.
• You can have a concussion and NOT lose consciousness.
• Learn the five steps to a graduated return-to-play protocol.
• Master the log roll.
• If an athlete remains unconscious, you must assume a broken neck.
• If an athlete’s arm is stinging or burning but there’s no neck pain, assume an injury to the brachial plexus. Sideline him unless the injured side can move as easily and with the same strength as the uninjured side.
• With a normal neurovascular exam and lacking the experience to reduce the dislocation, immobilize in a splint and transfer to the ER.
• If no pulse and a long drive to the hospital, one attempt to reduce it with longitudinal traction might save the limb.
RETURNING TO PLAY
• Perform a functional assessment by asking the athlete to show you he can use the affected side doing what his sport demands. For instance, very few sports rely only on running straight ahead, so ask the athlete to cut, twist and stop on the injured joint.
Want to learn more?
Since Petrizzi and Cole started SMART, more than 500 physicians, athletic trainers, coaches and emergency personnel have completed the workshop. It has been offered at medical conferences across the country as well as local events and in small group settings. It is also a highlight of the VCU Sports Medicine Update in Primary Care conference. Sponsored in part by the VCU Continuing Medical Education Office, this year’s conference will be held Dec. 5-7 at Kingsmill Resort and Spa
in Williamsburg. Learn more and register at www.vcuhealth.org/cme.