The most important aspect of sports, be it local, backyard, or international, is to ensure the safety of the participants. This mandate has become the rallying call of sport medicine associations worldwide, ever since this important branch of medicine became ‘mainstream’ in the early 1960s. Most international sporting associations now make it mandatory that teams have as part of their ‘official’ delegation, a member of the medical fraternity with proven expertise in identifying, managing, and treating injuries. However, before identifying, managing, and treating injuries to team members, the medically trained individual must first advise and implement procedures to PREVENT injuries. LACK OF KNOWLEDGE Unfortunately, whereas this fundamental requirement is strictly adhered to in some international competitions, where the medical person is identified and given an official role and responsibilities, the paucity of such individuals has allowed some organisations to appoint persons with basic medical qualifications but with an alarming lack of specific knowledge of the sport to which they have been appointed. This lack of knowledge soon becomes apparent to the technical staff assigned to the team, with the resulting (and unfortunate) sequel where medical advice is rarely sought and if obtained, studiously ignored. I have noticed this flaw/anomaly, and my investigation has led me to believe that economics seem to be the driving force behind this potentially dangerous practice. I have found that there is no sporting organisation that deliberately goes out of its way to appoint medical personnel, to fulfil rule requirements, who lack either expertise or experience in the skills required for this important aspect of team selection. The individuals who have taken the time (and sacrifice) to get trained in the basics of sport medicine, generally tend to have pressing economic needs that somehow have to be acknowledged. Therefore, because of the cost involved, teams often tend to request friends and associates with medical qualification in an unrelated field to ‘volunteer’, thus fulfilling the rule requirements of the sport. In Third-World countries where money is generally tight, this usually works, until the technical ‘expert’ in the team believes that he/she knows more than the medical appointee. This ‘stand-off’ usually occurs when a ‘star’ player is involved. I have known of cases where a key player has suffered a fractured leg during a strategic stage of a football final and the medic on duty is beseeched with instructions to “just bandage the leg. Don’t take him off. If him come off, doc, we dead!” Amazingly, this request was compounded by similar sentiments from the player himself! In football, the great Franz Beckenbauer of the then West Germany was allowed to continue playing in a crucial World Cup match with a dislocated shoulder, because “if him come off … we dead”. In the NFL recently, star quarterback Cam Newton was allowed to continue playing after suffering an obvious head injury in a game where recent lawsuits by NFL players with brain abnormalities, who were encouraged to continue playing by technical and sometimes medical personnel, are becoming more and more frequent. The recent, untimely sudden death of youngsters involved in sports in Jamaica has galvanised interest in pre-participation-evaluation by schools that have been sending team members for evaluation. But, if a star player is sent for an evaluation before a crucial game, and that evaluation detects an abnormality that needs further investigation before clearance is obtained, the star player is allowed to play, with no one taking responsibility for the obvious breech of agreed protocol. This defiance of medical advice became international news last week when it was revealed that the team physician of the Trinidad and Tobago national senior football team, Dr Terence Babwah, a member of the FIFA medical committee for over 10 years, resigned because his professional integrity and that of the team’s medical staff had been compromised by decisions leading up to the Honduras game. Dave Isaac, the team physiotherapist for the past four years, has also resigned. Dr Babwah’s resignation has brought into sharp focus the importance of medical advice to teams given by those entrusted with the awesome responsibility to PROTECT squad members from possible serious injury. The team member was the goalkeeper, Jan-Michael Williams, who, during the game, suffered a head injury and had to be substituted 10 minutes into the game. Apparently, the medical team had advised against his playing the game in the first place! It is high time that administrators of team sports in Jamaica ‘take sleep mark death’ and begin to make rules and protocols that MANDATE that the medical advice given by suitably qualified medics is followed, with serious consequences for proven defiance of their advice. Unsubstantiated rumours about medical advice being ignored in the death of children involved in sports, makes this call an urgent priority.