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The 2018 FIFA World Cup again emphasised the challenge of on-field management of a concussed athlete; there was no shortage of disagreement among expert commentators and claims of questionable medical decisions.1
Team physicians often insist on having the sole decision-making responsibility in removing a player with suspected sport-related concussion from play. This is frequently met with resistance from other concerned parties, including the coach and the athlete.2 Good progress has been made to address this problem with the introduction of the SCAT protocol,3 legislation, policies and education across sports, leagues and countries, such as World Rugby and sport in general in the USA. However, in our experience, even with policies in place, compliance remains poor in several sports and many parts of the world, especially in non-professional sport. This became evident when two experienced clinician authors (LH and JP) were tasked to implement a sport-related concussion programme in soccer (football) leagues in Qatar. Despite FIFA guidelines on concussion care, low levels of knowledge and negative attitudes were encountered from at least some people at management, player and medical levels. It became clear that engagement and education at several levels of the sport would be required for successful implementation of effective concussion care.
We explore four factors that contribute to this complex issue and propose a three-part approach to the removal of players with suspected concussion from the field of play to improve this aspect of concussion care.
Ethics and shared decision-making in sport and exercise medicine
Shared decision-making is usually done by a team consisting of the patient as central figure, the medical care provider and significant others. In Sport and Exercise Medicine (SEM), the team typically consists of the patient, the sports medicine physician and/or physiotherapist, and the coach/manager,4 with possible input from the agent. In youth sport, parental input is also relevant. Until now, …
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