Commentary: Student Medical Histories

**sambosteve** · Posted On: 5/08/2010 5:45pm

I had an experience at the club last night that prompted me to write this commentary.

As a school owner (and medical professional) I always make sure to get a brief medical history of my students before they start training the club. It is amazing how many new students will neglect or forget to include important medical information if left to simply fill out the school application on their own unchecked. The medical history section will often be left blank until I question them about it. Then after some basic questions from me regarding prior surgeries, allergies, illnesses such as asthma, diabetes, etc, people suddenly remember. How many times I have heard statements like: "Oh yeah, I forgot about that" or "Well, my diabetes is under conrol" or "I had surgery, but that was years ago" or "I did not think that mattered".

This is not to say that they omit information on purpose, but oftentimes people who have had past medical concerns or current issues which are well managed, will not consider them current medical concerns. How many times have I had to remind students with asthma, for example, to keep their inhaler handy? Too many. It must be explained to them that training with one's body the way we do may put the body under new pressures which may aggravate old injuries, or even current issues which are managed well. New students often have an "out of sight, out of mind" attitude towards their health. This can be potentially very dangerous.

It is extremely important to take at least basic medical histories of our students. Furthermore, it is equally important to get an emergency contact for our students. Again, this is often left blank on the enrollment forms...until I specifically request the information. Equally important is that instructors get trained in basic first aid and CPR and have the proper supplies available. How often have I seen injuroes in clubs where they did not even have ice packs available? It is our responsibility as coaches to do this.

Then, there are the occassional students who will not admit to medical concerns due to ego, embarassment, or just a desire to look "tough". The old "no pain, no gain" motto. How often during class do people experience problems they do not share, only to regret it later?

This brings me to my experience at the club last night. After class one of my students (18 years old) was feeling dizzy, seeing stars, and experiencing a headache. This is not something which he normally experienced to my knowledge. They are also symptoms of several potential serious issues.

While talking to him, I discovered that he had been experiencing symptoms like this for several weeks in and out of class, but had not shared it with anyone because "he did not want to worry anyone". More likely, because he himself was scared of the possible results of looking into the issue.

He wanted to go home on the subway, but I kept him at the club a bit to see if the problems would persist. The class was a relatively low impact class and he had experience no head trauma. During our discussion in the changing room, his nose spontaneously started bleeding. Not a good sign. He still wanted to leave on his own. I forbid it.

I kept him at the club and insisted a visit to the ER. I called his mother, who was also not aware that he had been experiencing such symptoms. He had never told her. So, his mom went to meet us at the ER.

By the time he got to the ER, his state had deteriorated significantly, he could not walk, and was very disoriented. He could not recognize his mother when we got there. Thank God he did not go home on the train on his own!

So, he was admitted and at this time, after many tests, the diagnosis is still unknown. However, some key things have been ruled out like a tumor. However, a cyst causing intracranial pressure was discovered (non malignant it appears). He is also being assessed for a previously unknown seizure disorder. But, the jury is still out.

So, folks, here the moral of the story:

If you run a club, you must know that your students may not always be up front with you about their health. And even if they have been, there is always the possibility of unknown issues arising during training. As a coach, you must have basic first aid knowledge and most of all a willingness and means to act upon what you assess. If you smell trouble, act on it. If it turns out to be nothing, great. But if, like my experience last night, it turns out to be something critical, you will be glad you did.

Lastly, you must have emergency contacts for all your students. Don't let students slide on this or their medical histories for that matter. Students who train with us are literally putting themselves in our hands. It is a huge responsibility. It is our responsibility to do our job and get the info and training we need so in the case of an emergency, we can do the right thing by the people who trust us and maybe even save a life.

**CoffeeFan** · Posted On: 5/09/2010 9:40pm

Wow, well said Steve. I hope all the best for your student.

**Robstafarian** · Posted On: 5/09/2010 11:29pm

Very well said Steve, though it's a shame that it needed to be said. This is exactly why I won't train until I get health insurance (which probably means a move to Canada [no political responses, please]).

I hope your student makes a quick, and affordable, recovery.

**sambosteve** · Posted On: 5/09/2010 11:40pm

Thankfully he has health insurance and his mom works at the hospital we went to, so he got seen quickly (he would have anyway since it was urgent, but knowing people helps).

He was discharged today I believe, but I don't have a follow up...other than it was not a stroke or cancer thank God.

**It is Fake** · Posted On: 5/09/2010 11:45pm

Originally Posted by sambosteve

If you run a club, you must know that your students may not always be up front with you about their health. And even if they have been, there is always the possibility of unknown issues arising during training. As a coach, you must have basic first aid knowledge and most of all a willingness and means to act upon what you assess. If you smell trouble, act on it. If it turns out to be nothing, great. But if, like my experience last night, it turns out to be something critical, you will be glad you did.
.

Spot on. At least you came out on the brighter side of things. One of my fellow former instructors had a guy die from a massive heart attack in his school. He was never the same because, he never asked the questions.

**sambosteve** · Posted On: 5/10/2010 12:06am

Originally Posted by It is Fake

Spot on. At least you came out on the brighter side of things. One of my fellow former instructors had a guy die from a massive heart attack in his school. He was never the same because, he never asked the questions.

Jesus, that is horrible. I would not wish that on anyone! This is unfortunately a very big concern in many gyms. especially small home grown garage gyms. But, I have seen it in long established gyms as well.

**It is Fake** · Posted On: 5/10/2010 1:28am

He realized it wasn't his fault but, the guy had symptoms that were noticeable when it was described. You were adamant and the guy I knew wasn't.

He noticed the guy didn't look right but, allowed him to continue. Truthfully we are adults and should know better but, ego does get in the way. It was worse because, his wife was in class as well. he stopped to get a drink, after some prodding, and drop dead a few seconds later.

Edit:

Here is something stranger. We had a guy who was new and sparring basically saved his life.

**sambosteve** · Posted On: 5/10/2010 6:00am

Originally Posted by It is Fake

Here is something stranger. We had a guy who was new and sparring basically saved his life.

Story please...

**Mtripp** · Posted On: 5/10/2010 7:27am

A few thoughts:

Most Red Cross places offer certification in "Sport First Aid." This includes CPR for adults and kids, and other lifesaving methods.

Your school needs to have a plan, in writing and posted. Who calls 911? Who moves the students out of the area and watches him? Who applies first aid? Often missed, who watches for the ambulance and guides them to the injured party.

All of this is covered in the American Coaching Effectiveness Program, or ACEP.

Amazon.com: ACEP First Aid Manual, 3rd Edition (9780756649821): DK Publishing: Books

Amazon.com: Rookie Coaches Wrestling Guide: American Coaching Effectiveness Program in Cooperation With USA Wrestling (9780880114219): American Coaching Effectiveness Program, U S A Wrestling: Books

A few years ago they changed their name; here is their current web site, and if you are coaching, you need to spend some time there:

http://www.asep.com

**It is Fake** · Posted On: 5/10/2010 8:28am

^^^ Agreed.

Originally Posted by sambosteve

Story please...

Well, as we know most men are macho some of us tend not go get our yearly check ups. This is something you need to do anyway but, it becomes more necessary as you become older.

My former instructor had quit and the new guy was a firefighter with a rotating schedule. So, basically the newest instructor would rotate 4 days, 8 days, and 12 out of 22 days. I was co-instructor/Assistant.

One of many days I was watching sparring and we had a semi-spastic yellow belt. He wasn't terribly out of control unless, he got hit with a good shot. This day, he went spastic and dislocated or broke his finger. I'm no doctor, nurse or medical assistant so I wasn't sure. My advice was to go get it looked at. He popped it back into place and kept training. It swelled immediately.

I told him to get it looked at but, he insisted he would ice it down and it would be okay. I have seen a few minor breaks during sparring and they had swelled rapidly like this injury. After must protestation he said he would go get it looked at.

I said "what's the worse that could happen? You have to pay a $10 dollar co-pay?"

We didn't see him for two weeks.

When he finally returned his finger was bandaged and he had stitches in his finger. He had one of those silver ugly immobilizer on and you could see the stitches. I thought it had been damaged due to the break and a novice popping it back into place. Turns out he had lesions inside the bone of his finger. The surgery was exploratory to obtain a biopsy. He had bone cancer in that finger. The doctor told him that is why it broke so easily. He hadn't been to a cheek up in years and if he hadn't of broke his finger it would have most likely been caught to late. His prognosis was good but, due to chemo and the drugs he had to drop out but, it was going into remission a year or so later before I moved.