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Concept of an Executive Medical Boxing Board

 

I attended the Annual meeting in Las Vegas of the International Ringside Physicians where six other Florida physicians were present including Dr. Alan Fields.  As an inspiration from this meeting I wrote some notes and thoughts for the Boxing Commission.
 
They are in no particular order or significance, just thoughts.
 
As in all professional organizations, continuing education and established training and experience creates consistency and quality. 
 
1.  Consider establishing a Medical Board to review all deaths and serious injuries.  (Dr. Alan Fields would be the perfect Chair to organize this Board).  The Board should have a representative from the field of Neurology or Neurosurgery, Ophthalmology, Ear, Nose and Throat as the basis with possibilities of a Physical Medicine and Rehabilitation and Orthopedist as alternative members.  These should be Board Certified in their specialty, attended at least one annual conference and had at least two years of physician boxing experience.  They can review and amend the practices of ringside physicians as well as review post fight injuries.  They can also help clarify clearances to fight in cases of questionable medical conditions for fighters.
 
This group can coordinate a summary for all deaths to give recommendations on any revisions to pre fight physicals of post fight examinations.  All reports would remain with the commission.
 
As trainers and managers fail to reveal any history of injury, subsequent findings by physicians in the pre or post fight examinations that find objective evidence of obvious medical problems of concern should be reviewed by this Board and if appropriate make recommendations of suspensions of the fighter's representatives.
 
2.  Medical Guidelines of Care in Pre and Post Fight Situations.  Physicians need standards of care to ensure that expectations of care and treatment are outlined before the event.
 
(a)  Post Fight Suturing of cuts.  Some cuts can be managed by Steri-strips of Band-Aids, but some require sutures.  Objective guidelines should define the difference.  As cost is involved with the treatment of these lacerations, some physicians who suture in their practice offer the suture the lacerations in the fighter's locker room.  Other physicians who do not regularly suture, refer to the local medical facility.  Concern to non-suturing physicians is the lack of a sterile environment in the training room, but more importantly, lack of consent to treat, lack of follow-up care and the cleanliness of the wound before closure.  The burden of litigation should an infection like MRSA (the flesh eating bacteria) would be high as no consents are signed and lack of documentation of services provided.
(b)  Guidelines to post concussion headaches.  As physicians we should have a sheet that summarized types of headaches and when a fighter should seek medical help as emergency room do with pre-printed fact sheets on every medical condition.  This at least gives some direction to the fighter and his trainer of warning signs of a intra-cranial bleed.  This information sheet can be easily copied as all Emergency Centers have pre-printed information.  We would need the Medical Board approve which sheets are appropriate to use.  These sheets should be copied and available from the commissioner at the event for the physician to request.
(c)  For new physicians we need a small handbook to common fight injuries and how to care for them.  Examples include, septal maxillary fractures, wrist bone fractures, biceps ruptures, knee and other joint injuries, lacerations that effect the boxer versus non-interfering lacerations and bleeds, eye injuries and signs of neurological changes including simple concussions.
(d)  Information for physicians on over the counter medications that are allowed versus not allowed.  Inform them of the post test urine screen and what types of substances they are screening.
 
3.  New physicians are at a disadvantage (unless Dr. Alan Fields is assisting) in knowing what is expected of them as frequently each physician approaches the pre and post fight physicals with a wide spectrum of variation. 
(a)  New physicians should be required to assist in their first fight with a "senior" ringside physician, such as to get proper "orientation" to the situation.  The "senior" physician should  be paid more on that first event as he serves as a mentor and is teaching the new ringside physician.
(b)  New ringside physicians should attend one conference from the Boxing Association for Continuing Education within the first year or two of their participation to recertify their expertise.  This certificate of participation should be faxed or mailed to the Boxing Commission and tracked.
(c)  As all other officials of the Commission are evaluated for their basic competence, a periodic review of the ringside physician should be created and the more competent and experienced physicians should hold precedent in determining assignability to events.  Main events should only be attended to by the most experienced ringside physicians.  The designation of experienced ringside physicians should be "senior" and a list should be created to rank the physicians as well as noting the regions that they can best serve.
(d)  Physicians need to understand the differences in boxing versus mixed martial arts.  Although an experienced ringside boxing physician, attending a mixed martial arts venue is treated as a novice physician as there are new rules and screens that need to be performed by the physician.
 
4.  Boxers-Fighters do not "share" any history of surgery, trauma, recent infections, eye damage to the physicians.  One reason is that physicals are done in an open setting with no privacy.  Frequently the opponent is sitting alongside his opponent and trying to find weaknesses in the boxer-fighter.  Exams need to be held one on one with privacy as is expected in any medical setting.
 
5.  Lack of Boxer-Fighter Past Medical History.  As in all other sports a baseline physical is made by their own primary physician to starting a sport, especially in high school and college, a boxer may be required to have an annual physical by his primary physician in the past two years of his/her event.  This places a large burden or medical liability on the primary physician should any pre-existing injuries of surgeries be hazardous to further contact sports.  Additional information needed in an emergency situation (usually an unconscious boxer) are Medication Allergies, Blood Type, Vaccinations up to date, Recent Medical history as well as contact telephone numbers of spouse, parent, significant other who can provide any information as well as kept informed of the medical status.
 
6.  Change in neurological status is critical to the diagnosis of a medically serious and life threatening brain injury.  The post fight Glasgow Coma Scale is a 15 point scale.  Almost always a 15 is given.  Any number less than 15 needs to be sent to the Emergency Room for diagnostic testing to assess for possible bleed in the brain.  As a secondary safety and medical review, all non 15 scale numbers should be referred to the Medical Board (to be created) for review and summary comments to be given to the commission.  A summary of any non 15 score should contain a concise medical documentation post fight by the examining ringside physician.
 
7.  Continuing Education.  This is done by the internet of conferences.  Consider creating a monthly email newsletter from the Boxing Commission that has some interesting topics that update the ringside physicians and hopefully improve their boxing-mixed martial arts knowledge.  If possible, these medical topics could be created to give Continuing Medical Education credits for physicians as well, but this takes effort and time, not the least money.
 
8.  Paramedics who assume care of a boxer they have no idea of history are at a significant disadvantage.  I propose that copies of all pre fight physicals of the boxers be copied, placed in a sealed envelope for confidentiality and given to the paramedics who are at the event.  In the case of an injured boxer, they can open the envelope, find the participant and start relaying medical information to the emergency room physician the history of the patient.  As more than one boxer may be injured, a second copy should be made and be available to the next team of paramedics.  Cell phone numbers of the physicians who performed the pre-fight physicals should be given to the paramedics in case the emergency room physician needs to contact the last doctor to examine the fighter before a serious injury occurred and most of the time the boxer is unable to communicate.  If the sealed medical records were not needed by the end of the event, this packet of medical records is to be returned by the paramedics to the commission official overseeing the event, then properly disposed by shredding as this is a viable medical file and confidential.
 
9.  Any hospitalization of more than one full day represents a serious medical condition and possibly medical liability.  I propose that in the event of a hospitalized participant, the Commission require statements from at least the pre and post fight physician (should they be different), the referee, the judges, the leading official of the Commission present at the event, and all the trainers and managers of the fighter as well as the fighter him or herself.  This should then be reviewed by the Medical Board and the Boxing Commission for findings and recommendations.
 
10.  Closure of medical care should be documented at the end of the event.  The physicians should not leave unless the lead official releases them from their duty.  In order to ensure that all participant's medical needs are met, I propose that as they receive payment for their participation, they sign a statement that they have no further medical needs at this time.  When all the fighters have signed these releases, then the medical staff can be excused.  For practical reasons, only one physician is needed to remain, but that can be determined by the Boxing Commission official at the venue.
 
11.  Religious Holidays affect availability of physicians, especially devote followers.  Ask the ringside physicians which holiday weeks that are unavailable to minimize the risk of being depleted of available ringside physicians for the events to be scheduled.
 
12.  In the event of a tragedy of a fighter during or after a venue, the officials and the ringside physicians need guidelines on how to handle media.  The Boxing Commission needs to contact all officials involved and provide the materials for guidelines in dealing with complex media inquiries.
 
13.  Physicians come to the events with a wide range of medical equipment and supplies.  Some have basic items, whereas others bring a small "MASH' unit bag.  Please note the more prepared "MASH" unit bags are desirable, but novice ringside physicians need to be instructed on the minimal needs that are to be brought to the event.  A list of supplies should be established.  At the Las Vegas Conference a Canadian physician directed us to a web site which I find a good resource  www.canadianboxing.com .  The Canadians require two ringside physicians at boxing and three ringside physicians for mixed martial arts as MMA has more injuries and medical attention.
 
14.  Ringside physicians need guidance in certain medical situations.  Blind in one eye, hypertension (high blood pressure), tachycardia and or arrhythmia at rest (fast heart rate and/or irregular rhythm, abnormal electrocardiogram (EKG), and positive testing for HIV, Hepatitis B and C pre examination.  These guidelines can be established by the Medical Board.

 

Copyright © 2004 - 2012Taras V. Kochno, M.D.  All Rights Reserved
Board Certified in Physical Medicine and Rehabilitation

 

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