This time was different
It started off as just another high school football game, as so many Jay’s mom had watched from the stands over the years. Jay's mom cheered as she always had and chatted with the other parents. She had become accustomed to Jay’s tackles and tumbles and had gotten to the point of tuning most of them out.
Then Jay got tackled and Jay’s mom knew something was wrong. Jay caught a pass and was immediately tackled by a large linebacker who seemed to come out of now where. J was literally tossed into the air and to the ground. He landed on his arms still holding the ball. When Jay tried to get up, he couldn’t.
Jay’s mom, some other parents, the coaches and a trainer rushed to Jay's side. He was lying on his side holding his abdomen. Because he was awake and alert, the coaches decided to help him up. Jay staggered to his feet but was unable to stand up straight. He said his belly hurt too much. He wasn’t standing for more than a couple minutes before he became dizzy and sat back down. At that point, another parent called 911. Because the game was taking place in the middle of a big field with a huge town festival going on around it, Jay’s mom was worried that the ambulance would be unable to get to Jay through the throng of people so she asked another parent to help her get Jay to her nearby car. She then drove Jay straight to my office, a fairly sophisticated Urgent Care center.
A Happy Ending
Jay’s mom called en route to alert my nursing staff that she was on the way but didn't provide any details about his injury, so that when he arrived I didn’t know anything other than that he had been injured playing football. As soon as I examined Jay, I asked the nurse to call 911. He could barely walk and was hunched way over holding his belly. He had an “acute abdomen,” meaning that when I touched it he was basically on the ceiling with pain. His pain was over the liver and I was concerned that he lacerated his liver when he was tackled, an injury which could become life threatening very quickly without hospital attention. So, we didn’t waste any time. Upon arrival, the doctors at the local children’s hospital agreed with my preliminary diagnosis, and once Jay was stabilized and given intravenous pain medication, he underwent a CT scan which, thankfully, showed only a bruise to the liver and a couple broken ribs. After a few weeks of rest, he was back to playing football.
Jay was one lucky boy! The story had a very happy ending but could just as easily have ended in tragedy had his liver been lacerated. While his mother thought she was making the right decision in driving Jay to my office, Jay would have been better off had she waited for the ambulance. In situations like this, seconds really do count and where a child is evaluated by a medical team counts even more.
I was also struck by the fact that Jay’s mom received no advice from the coaching staff. She told me that, after Jay's injury, they basically scattered and she really didn’t know what to do. While many coaches and trainers would have helped mom stay calm and attended to Jay differently, clearly this team’s coaches didn’t have the best first aid and medical training. Very worrisome when you consider the high injury rate in contact sports
Types of Medical Care for Youth Sports Injuries
So parents are better prepared to select the best medical option when their child is injured playing sports, here’s a run down on the different kinds of care:
Office Care (same day or next day)
For minor injuries, especially musculoskeletal injuries, this is almost always an option. It is not an option, however, for head injuries, abdominal injuries or injuries to arms or legs that result in any deformity.
The usual rule of thumb is if your child is acting normally, the injury is likely mild enough to wait for an evaluation. But, if you have any doubt at all, call your doctor’s office for advice.For injuries you know need care, office-based care is the option most families prefer. Many pediatric offices have some sort of after hours coverage either on site or with other groups that you can usually tap into by calling your regular doctor’s office. This type of care is often like an emergency room in that it can handle many injury types and does a great deal of sports injury care. There is often some sort of lab access and even simple x-ray capabilities, although usually no formal radiologist coverage. Some offices even have sports clinics on site during the busy youth sports seasons. The best way to find out what level of sports medicine care your doctor’s office can provide is to ask. So much of sports medicine care for kids is considered routine injury care it may not be advertised as “sports injury” care.
familiar setting, since your child has been to the doctor’s office before
minimal wait time, since you have already set up an appointment
good level of care, since the treating doctor will be a pediatrician.
No subspecialty coverage
No sophisticated radiology capabilities (typically).
Referral to ER usually necessary for anything beyond the scope of simple appointment-ready situations.
Emergency Room Care
Some injuries are serious enough that they can't wait to be evaluated in a doctor's office and warrant an immediate trip to the emergency room.
- More expansive specialty coverage and can see all takers and all situations.
- If you have the option, try and take your children to a children’s hospital or a children’s emergency room. Many community hospitals now have fully functional children’s emergency rooms with a dedicated pediatric emergency room staff.
Long wait times possible for injuries not considered serious (a practice called "triage").
High co-pays with some insurance groups.
Increased likelihood that your child will be seen an adult emergency room doctor,, not a pediatrician (depends on the hospital).
Your Pre-Emergency Game Plan
While most sports injuries are minor, some can be very severe. You’ll know what to do by how your child is acting and behaving. The biggest challenge for parents during an emergency is often not recognizing that it is an emergency but in thinking clearly. That’s why thinking through, in advance, the nuts and bolts of the information you need to have on hand in case of emergency is so important. Pull these few items together in a piece of paper you can pull out quickly or a document you can call up on your phone, and you’ll be able to focus and know exactly what to do when your child is suddenly injured during sports:
List of immunizations and date of last tetanus shot
List of medications, doses and reasons for use
List of past hospitalizations and reasons
List of medication allergies
Last weight and height
Pediatrician’s phone number and address
Insurance company phone number
Your child’s insurance care information
I’d also suggest you put your pediatrician’s office and 911 in your speed dial and store the numbers in your cell phone's contact list so you can call without delay . Again, you don’t want to have to think in an emergency, you want to be able to just react. Thinking can happen later once your child gets to medical care – and knowing what to do and where to go is the first step to facilitating that.
Gwenn Schurgin O'Keeffe, MD is a pediatrician living in the Boston area and the founder and Editor-In-Chief of www.Pediatricsnow.com.
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