Pediatrics

Is There a Doctor in the Stands? A Brief Guide for When That Doctor Is You

Kacie M. Kidd, MD; Janani Narumanchi, MD; and Linda S. Nield, MD—Series Editor

A Parent Asks

As a parent, I try to attend all of my child’s practices and games. As a pediatrician, I am not sure how involved I should get when other children are injured. What skills do I need to help when children are injured, and what legal protections do I have? How can I become involved in a formal capacity? 

The Parent Coach Advises

The innate desire of the parent who is also a pediatrician to attend to an injured child at a sporting event is often muted by the concern for liability, lack of sports medicine training, and the discomfort of taking on the role of physician outside of the office. This brief guide provides the pediatrician with basic legal information surrounding this matter and outlines sideline interventions for the most common sports-related injuries. 

By The Numbers

It is estimated that 30 million children and adolescents in the United States participate in at least one team sport.1,2,3 Injuries obtained while participating in an organized sport are often measured in terms of “activity experiences”, or how many injuries occur per 1000 practices/meets/games, and so forth.4 With regards to male athletes, cross country is associated with the most injuries per activity experience, with 11 to 15 per 1000 activity experiences, followed by football and soccer.4 Cross country also ranks the highest in this category for female athletics, followed by soccer and gymnastics.4 

The types of injuries children experience differ based on age. Younger children (5-12 years) experience a nearly even split between overuse and trauma types of injuries (bone fractures, apophysitis, osteochondritis dissecans), whereas older children (13-17 years) experience significantly more overuse injuries as well as increased need for surgical intervention (anterior cruciate ligament tears, meniscal tears, spondylolysis).5 The middle age group (10-14 years) may have the highest overall rate of injury, and this is thought to be associated both with pubertal maturation as well as the increasingly competitive nature of sports at this age.6 Concussions occur at all ages and are quickly becoming one of the most concerning sports-associated injuries, accounting for over 250,000 pediatric emergency room visits from 2001 to 2005.7

The Legalese 

All states have legislation specific to “Good Samaritans” or those who attempt to help injured persons at the scene of an accident.8 These laws were established in order to persuade physicians and others to aid in times of need without fear of malpractice suits. While all states have slightly different legislation, most include language that protects those who aided “in good faith” and “without remuneration” (ie, without compensation).8,9 Some notable exceptions to these protections can be found, for example, in the law of New York State, which specifies that those who perform “gross negligence” (not conforming to accepted standards of care while also taking malicious action) can face legislation, and in Kansas where the law specifies that “negligence” alone is enough for a potential civil suit (not conforming to accepted standards of care).10,11 The Kansas law goes further to specifically outline protections for providers caring for minors without parental permission.11 

Two states (Minnesota and Vermont) allow for penalties against individuals who walk away from an emergency.12,13 Pediatricians are strongly encouraged to become familiar with laws of their own states concerning providing voluntary care while at sporting events. State government websites serve as the best way to access this information. 

How To Respond

The Table lists the most commonly encountered categories of injury and also provides suggestions for initial management of these injuries. The referenced sources provide more detailed information and can be instrumental in developing a pediatrician’s confidence in assessing and managing sports-related injuries. 

Getting In The Game

Pediatricians want to be able to help the injured athlete, and acquiring a better understanding of local legislation and enhancing one’s sports medicine training will increase the likelihood that more pediatricians will be able to help. For those who want to become involved in an official capacity, youth sports teams could definitely benefit from having an official team physician. Pediatricians are encouraged to reach out to coaches, athletic trainers, and school administrators and express an interest. It is important to list your credentials and know the training of those around you. Further information on this topic is available in the listed additional resources and references. n

Additional Resources

American Academy of Orthopaedic Surgeons. Essentials of Musculoskeletal Care, 5th ed. Rosemont, IL: Amer Academy of Orthopaedic; 2016.  

Brukner P, Khan K. Brukner & Khan’s Clinical Sports Medicine, 4th ed. North Ryde NSW, Australia: McGraw-Hill Education; 2011. 

Kacie M. Kidd, MD, is an internal medicine/ pediatrics resident at West Virginia University School of Medicine in Morgantown, West Virginia. 

Janani Narumanchi, MD, is an assistant professor and clinical faculty in the department of pediatrics at West Virginia University School of Medicine in Morgantown, West Virginia. 

Linda S. Nield, MD—Series Editor, is a professor of pediatrics and medical education at West Virginia University School of Medicine in Morgantown, West Virginia.

Acknowledgements

The authors thank local team physicians and West Virginia University clinicians Brenden Balcik, MD, and Benjamin Moorehead, MD, for their expert review of this work.

References

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10.NY CLS Pub Health. § 3000(a) (2009). Emergency medical treatment. 

11.KS § 65-2891 (2011). Emergency care by health care providers; liability; standards of care applicable. 

12.VT Title 12, Chapter 23, § 519 (1968). Good Samaritan Act. 

13.MN Statutes § 604(a)(1) (2015), Good Samaritan law.  

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