Stop by a Central Virginia-area high school football game on a Friday night and take a look at the sidelines. Chances are, a UVA resident is there.
That’s because many of UVA’s orthopedic and primary care residents volunteer to provide medical coverage at local high school football games. It’s a free service that UVA has provided to area schools for decades, according to David Diduch, MD, an orthopedic surgeon and the head orthopedic team physician for UVA athletics.
Residents are assigned to a local team as their schedules allow. First-year residents pair up with more senior-level residents. Everyone ends up covering about six home games per season on Fridays and Saturdays, says Diduch, who notes that faculty members mentor the residents throughout the season and cover games as well.
The high schools covered are Western Albemarle, Charlottesville, Monticello, William Monroe, Fluvanna, Covenant, Blue Ridge School, Fork Union and Woodberry Forest.
Benefits for Both Sides
For Jeff Tuman, MD, a fourth-year orthopedic resident, it’s a win-win situation.
“I think it’s a really good way for us to give back to the community. These schools don’t have to pay for this,” he says. “And it’s also rewarding for us in terms of our education.”
Tuman serves as the team physician for Woodberry Forest and also Blue Ridge. He played soccer for UVA from 2001-2005. “I understand the athlete’s side of it,” he says. Tuman wants to be a team orthopedic surgeon at a school like UVA.
He’s quick to point out that the schools’ athletic trainers usually take the lead when there’s an injury. “They know the athletes well. They’re with them every day in practice.” Tuman says he and the other residents step in when they’re needed.
Training Residents to Cover Football Games
Just like the athletes, the residents also need training before they go to a game.
“Typical medical school and residency education doesn’t handle how you cover an event, how you manage injuries and other situations on the sidelines,” Diduch says. “You don’t really get heat illness management, concussion management, things like that.”
So Diduch started an intensive, one-night training session to meet those needs. The session is held each August before football season starts. This year, residents in orthopedics, physical medicine and rehabilitation and family medicine participated, as did team doctors from James Madison University and the University of Richmond and trainers from area high schools. A group of orthopedic sports medicine fellows from a program in Richmond also make the trip every year because they have found it so valuable.
Topics covered include:
- Professionalism, including issues like where to stand, when to go on the field and when to not go on the field and working with team trainers, EMTs, parents and coaches.
- An overview of basic orthopedic injuries like dislocated shoulders, knee injuries, ankle sprains and broken bones.
- Heat illness, which is especially important in early-season games.
- CPR recertification and refresher training
- Managing various types of football equipment for a player with spinal injury.
Concussion and Head Injury
A key topic covered in the training is sideline evaluation of concussions and head injuries, a topic not generally taught in orthopedic residency, Diduch says.
Residents learn about the SAC score (standardized assessment of concussion), a numerical evaluation system that helps doctors determine if an athlete has a concussion.
“You’re testing recall. Do they have amnesia for prior events?” Diduch says. “You’re testing whether they can create memory and process things appropriately. And you’re testing whether they can think clearly.” All the residents get wallet cards with basic head injury evaluation guidelines and SAC score information.
“You give the residents a tool to assess head injury and really quantify it,” Diduch says. “Every kid’s going to be different, just like they are academically, but you can test them and you can wait a little while and test them again to see if the kid is deteriorating. Is this somebody I need to send to the ER? It’s a pretty good tool.”
Fifth-year orthopedic resident Marc Haro, MD, says the SAC score system and the wallet card are especially helpful because he doesn’t know most of the football players. “It’s a good way to objectively evaluate. Everyone has a different personality.”
Haro, who played high school baseball and football and was an athletic trainer and a physical therapist before he went to medical school, provides coverage for Fork Union’s prep and varsity teams. He notes the increased focus on head injuries in pro sports and at the high school and college levels.
“We definitely see it in high school football. The symptoms are very subtle and not so clear cut. In the ‘90s, the focus was more on getting the kids back in the game as quickly as possible. Now, the focus is taking them out and assessing them.”
Dealing with Spinal Injuries
Residents also learn how to take care of players with possible spinal injuries. Football trauma issues are very different from injuries that people get in car or motorcycle accidents, Diduch points out.
With motorcycle accident patients, doctors usually remove the helmet right away, but with football players, the helmet needs to stay on with the shoulder pads while the player is transported and even as he has X-rays or CT scans. That’s because the helmet and the pads work together to keep the player’s spine aligned properly.
“If you just take the helmet off and you leave the shoulder pads on, the player’s head drops down, which can really cause harm,” Diduch says. “They balance each other to keep the spine aligned. But the facemask needs to come off for airway access, and our training session gives these residents a chance to learn and practice how to do that.”
It takes a team of people to remove all of the player’s equipment properly, he says. The residents practice spine-boarding players wearing football equipment (placing players on a board designed to provide support and restrict movement), and they learn what to do if they’re on call when a player comes into the emergency room.
“I can’t tell you how many times the people we’ve trained have made a difference when somebody arrives in the ER. They can speak up and say, ‘Don’t take that helmet off. Here’s the order we have to do things,’” Diduch says.
According to Diduch, the training has paid off in the emergency room and on the field.
‘We’re equipping these residents to treat players on the field and in the ER. That’s what being a team physician is all about. We are equipping these guys to do this both now and when they are practicing in their own communities in the future, hopefully continuing to volunteer their time.”