TJB responds to crisis This obvious crisis in sports has sparked a tremendous response from Team Jamaica Bickle (TJB), an association in the United States of America with a long and impressive history in providing assistance to Jamaican children involved in sports. As a result of this ‘crisis’, TJB will be presenting 15 automated external defibrillators (AEDS) to pre-selected schools on October 14 at the JAMPRO headquarters in Kingston. In addition, training in the use of these machines will be provided by experts from the diaspora health-care sector. The CEO and founder of TJB, Irwin Clare, has stated that some of the schools selected lacked strong support programmes or were identified after collaboration with ‘old students’ associations in the diaspora and the UNIA. This humanitarian gesture is a continuation of the efforts of The Heart Foundation of Jamaica (HFJ), the Heart Institute of Jamaica and the group of high-school principals, known as the Inter-Secondary Schools Association (ISSA), to identify children at risk. Out of the crisis generated by Dominic’s untimely passing comes the opportunity for us to ensure that sudden cardiac arrest (SCA), when it occurs, is speedily identified and treated. The SCA occurs when the heart’s electrical system goes haywire (ventricular fibrillation) and stops blood flow from the heart. The heart function ceases abruptly and without warning. When this occurs, the heart is no longer able to pump blood to the rest of the body. The initiative from the HFJ, the Heart Institute of the Caribbean and TJB will identify those children at risk and improve the response time in the event of a cardiac arrest through the availability of AEDS, training of the support staff of schools in cardiopulmonary resuscitation, and improved ambulance/transport response times. Children at risk for SCA can be identified by completing a questionnaire (a pre-participation evaluation – PPE), where specific questions regarding unexplained fainting or palpitations, history of heart disease, heart attack or sudden death in the family, chest pains or shortness of breath during exertion are captured, followed by a detailed examination and a 12-lead electrocardiogram (ECG). These children so identified would then be subjected to more detailed tests supervised by a cardiologist. We must not allow this opportunity to be proactive in the care of our children during school-sponsored athletic activity to pass us by as another nine-day wonder as has happened before, where PPE of all children before taking part in ISSA competitions began in 2014 but fizzled in 2015. We cannot afford to continue to fail our young sportsmen and sportswomen. The PPEs must become mandatory for all ISSA-supervised competitions. The funeral of St George’s College’s Manning Cup captain, Dominic James, received extensive media coverage over the last weekend. The tributes were real and emotional as the nation said farewell to a child whose life epitomised the best attributes of a son, a friend and a football star. Dominic’s death is the latest in what seems to be a slew of deaths involving our children during sports. We already know that one swimmer, death was recorded in 2011 by the Swimming Association, a 17- year-old cross-country Jamaican athlete in February 2014, a 16-year-old footballer associated with Jamaica College, a 15-year-old student in Marymount in January 2014, and now 18-year-old Dominic. It was President John F. Kennedy who said: “When written in Chinese the word ‘crisis’ is composed of two characters: one represents danger and the other represents opportunity.”
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.