This topic is closely linked with ethics in sport. Over the past year I have had 2 separate clinical experiences while at the USSA hockey tournament in July 2019.

While at the USSA hockey tournament, I was the physiotherapist of the UWC men’s first team. On the 4th day of the tournament, the team played against UFS (Kovsies) and managed to have a 2-0 lead, until the goalkeeper collided with the opposing striker and his head hit the astroturf in a very rapid motion. I proceeded to assess the player after the umpires allowed me to run onto the turf, he managed to pass an on-field head inury assessment initially, and with my limited knowledge, I used the Glasgow Coma Scale and the finger-to-nose test as my assessment tools- the player scored 15/15 on initial assessment and completed the finger-to-nose test, but the player was visibly hurt and unwell.

However, upon reflection, I should have used a more effective tool to assess the player’s head injury. According to McCrea, Perrine, Niogi & Härtl (2012), the Sport Concussion Assessment Tool-2 (SCAT-2) is an inclusion of many neurological and cognitive independent tests imbedded into one assessment tool, and is the test used by most professional sports teams around the world. The SCAT-2 consists of orientation questions, verbal learning of 5 words over 3 trials, digit span backward,  a delayed recall of the 5-word list, as well as cerebellar testing and balance testing (McCrea, Perrine, Niogi & Härtl, 2012).

According to Physiopedia (2019), the typical ethical conflicts of interest amongst sports physiotherapists, athletes and coaches are conflicts about acting in the athlete’s best interests and pressure to return to play from a coach, parent, athlete or administration (Physiopedia, 2019)

The difficult situation I was in was due to the fact that the player begged me to stay on the turf, and I told him I was giving him 2 minutes and then decide whether or not to substitute him. After those 2 minutes, the golkeeper was squatting and disoriented, and I told the coach and the manager that he needs to be substituted and taken to hospital immediately as he was presenting with slurred speech, not oriented to time and place, and he was overwhelmed with dizziness. So in his best interests, he had to be escorted off the turf (Physiopedia, 2019)

After going to the hospital, the player reported that he was diagnosed with whiplash and a grade 2 (mild) concussion-a loss of consciousness for less than 5 minutes or amnesia 30 minutes to 24 hours (McCrea, Perrine, Niogi & Härtl, 2012). 

I had a huge ethical dilemma after the match as I was approached by one of the people in the stands, who asked me whether or not I was risking the player’s health by letting him stay on the turf, and I proceeded to defend myself and let that person know that I was in constant communication with the umpires, timekeepers, and our coach and the keeper was instructed by the coach to just stand in the goals for the next 2 minutes. Unfortunately, that person was not convinced by what I had to say.

However, I began to doubt whether or not I made the right decision and whether or not I compromised the player’s safety or health and acted in his best interests from the beginning. I was second-guessing myself until the player was diagnosed and treated. What made the decision even more difficult was that the player begged me to let him stay on the field to prove that he could still play. Luckily, the player was taken off without any further harm being done to him in those 2 minutes and taken immediately to hospital, where he was diagnosed and treated. That player was sidelined for 4-6 weeks, effectively a season-ending injury. The player is now undergoing rehabilitation for his whiplash injuries, and is near the return to play phase.