Dr Jim McShane is a General Practitioner in Dun Laoghaire and a member of the Faculty of Sports & Exercise Medicine. He is the Deputy Coroner for County Dublin and is also the Programme Director for the TCD/HSE Specialist Training Programme in General Practice. Jim has extensive experience in sports medicine, having worked with Leinster Rugby and the Irish National Rugby team for the past 13 years.
Dr Jim McShane
Many of us GPs and hospital doctors are lucky enough to have children involved in sport. We therefore spend many hours on sidelines around the country. It is natural then that some of us provide medical expertise when called upon. Often this medical expertise is given on an informal and as-needed basis, and that is fine. It is, in my opinion however, preferable if there is some formality put around this. This can simply be letting the coach know before the game you are there and happy to be called on if required. This will focus your mind and prepare you mentally if you are called upon.
Medical cover on a more formal basis can also be given to our children’s teams and other local sports teams. This is more demanding and can involve more than just pitch side work; planning the season’s rota, pre-season talks on injury management to parents and coaches, as well as injury follow-up in the days or weeks following games are just some of the duties that will befall us in this role.
If we are undertaking any such roles, we should be prepared! To me, part of being prepared is being appropriately attired and the most important piece of attire is a pair of football boots. Wearing boots will prevent you slipping or falling, and will save your shoes from being destroyed.
We should carry a medical bag and this should match our capabilities. In other words, we should only carry equipment that we are able to use. We should not attempt to do things pitch side that are beyond our abilities and our training. Therefore, if your training allows you to suture, manage soft tissue injuries and stabilise fractures, by all means do so. If you don’t have the training, players should be referred, or the emergency services called if necessary.
Concussion is the injury of most concern to parents, coaches and doctors. It is now being taken very seriously by most sporting bodies and in this regard, the IRFU has led the way with its ‘Safe Rugby Programme’, a useful pocket guide to concussion in Rugby Union, which has been distributed nationwide. You can see a copy on the IRFU website.
Concussion is a complex injury and while there is much we don’t know and understand about it, we do know that it is an injury that must be taken extremely seriously. We now know that a player with a suspected concussion should be removed immediately from the playing field or training and they should not return. The player should be medically assessed, not left alone and should not drive a vehicle.
The visible clues of a suspected concussion are:
- Lying motionless on the ground
- Slow to get up
- Balance problems or falling over
- Grabbing/holding head
- Dazed or blank look
- Loss of consciousness
Concussed players may complain of the following symptoms:
- Nausea or vomiting
- Emotional liability
- “Don’t feel right”
- Feeling slowed down
- Feeling like “in a fog”
- Blurred vision
- “Pressure in head”
- Sensitivity to light
- Sensitivity to sound
- Concentration difficulties
- Neck pain
- Blurred/double vision
A player’s memory can be tested in order to confirm the diagnosis by asking the Maddock’s questions. These simple questions are:
- Which ground are we at?
- Which half of the game is it?
- Who scored last?
- Who did you play last week?
- Who won that game?
Getting these questions correct is not a reason to allow a player to return to play or train if there are signs or symptoms of a suspected concussion. Getting any of the questions wrong confirms the diagnosis of concussion.
The most important role we have in this area is recognising the signs and symptoms of suspected concussion and ensuring permanent removal from the playing field. Handing the player over to a responsible adult or parent follows this, with the advice that they should not be left alone or drive.
We may subsequently be consulted about when it is safe for a player to return to play. In rugby there are very clear guidelines:
- From U-6’s to U-20’s the player must not return for 23 days.
- Adults must not return for 21 days.
These periods include a minimum period of 14 days rest after the injury. If all symptoms have subsided, this is followed by a period of graduated return to play, which involves a graduated build in the intensity of exercise before returning to contact training or playing.
Coaches, parents and especially players themselves may not always agree with our diagnosis of concussion or suspected concussion. We have a duty to protect these players and by following these guidelines rigidly, in recognising the signs and symptoms, removing the player permanently, resting the player and only allowing a return to play in the appropriate time frame gives them the best protection.
The IRFU run weekend courses in ‘Safe Rugby’ for doctors, physiotherapists and coaches. These are really valuable and should be done annually in order to feel comfortable working at any level of rugby.
No extra medical indemnity is required to work as a team doctor, but I would encourage any doctor engaging in same to inform their insurers.
Being a team doctor is a most rewarding role. I would encourage anyone with an interest to get involved, especially if you are going to be pitch side anyway watching your son or daughter. It brings with it some responsibilities and we need to prepare and train ourselves appropriately.
Good luck and see you pitch side.
We have had many enquiries about GPs providing services as Medical Officers during sports events. As a GP, you should give due consideration to the possible implications of your role before you agree to provide services at such events and we advise you to ascertain exact duties and responsibilities before agreeing to provide such services. The Medisec Master Policy covers members for these events provided the work undertaken is that of a GP and not as an event doctor, who is responsible for crowd control, ambulance cover, provision of appropriate medical equipment etc. For further clarification on our Best Practices for General Practitioners, please visit our article on Sports Events.