Dear Colleagues in Ringside Medicine,
I am reaching out concerning a four-part series by Thomas Hauser about the New York State Athletic Commission, recently published in The Ring. In part one, Mr. Hauser criticizes NYSAC's Red Flag Policy, calling it "a step in the right direction," but "not enough.” This assessment, in which Hauser gives the impression that unstable fighters are simply held at the venue for observation, is based on either a misrepresentation or a misunderstanding of the NYSAC policy.
I am writing on behalf of the Association of Ringside Physicians to express our support for the NYSAC Red Flag Policy. This policy bears multiple similarities to the post-bout evaluation system designed by the ARP, in which fighters are re-evaluated 30 minutes after their initial post-bout exam. Both systems feature mandatory re-checks, allowing both redundancy and a measurement of change, and adding another layer of safety for fighters who would not be sent to the hospital immediately. Both policies also explicitly delineate a pathway for the escalation of care when warranted.
Establishing consensus on what constitutes quality athlete care is a critical part of our work as the ARP, and the NYSAC's Red Flag Policy is consistent with the standard of care for which the Association of Ringside Physicians advocates.
The NYSAC policy is listed below for your reference. Please find links to Mr. Hauser's article and the NYSAC's medical policy and procedures as well.
Don Muzzi, MD
President, The Association of Ringside Physicians
NYSAC Medical Standards for Combat Sports Professionals:
Part 1: Thomas Hauser Article Regarding NYSAC's Red Flag Policy
• Concern for traumatic brain injury (TBI) should be raised for every combatant who has had a tough fight in which multiple head shots were taken by the fighter or fighter suffered a knock down during the midst of the fight.
• DOES NOT MATTER WHETHER THE FIGHTER WON OR LOST FIGHT (at times concern for TBI is raised for the fighter who won the fight).
• Red flag is issued for a combatant for whom concern for traumatic brain injury/concussion is raised but who is NEUROLOGICALLY STABLE in the ring/ cage (during the fight) and in the immediate aftermath of the fight (stable when the decision is announced, stable when the combatant leaves the ring/cage, stable in the locker room immediately after the fight, stable at the time of post-fight physical immediately after the fight).
• The combatant has a Glasgow Coma Scale GCS score of 15 after the fight (any score less than 13 MANDATES an immediate transfer to the ER of a Level I trauma center for evaluation).
• Such a combatant (GCS has to be 13-15 but not less) deserves close PERIOD OF OBSERVATION post-fight and careful consideration before final medical clearance.
• PERIOD OF OBSERVATION: determined by the physician-may be anywhere from 15 mins to 45 mins.
• WHO can issue red flag?—ANYONE can issue the red flag-CMO,ACMO, COMMISSION OFFICIAL (ED/DOB), CHIEF INSPECTOR, INSPECTORS.
• HOW is it done-communicating it to any Commission official at the venue or to the ringside physician or by the CMO/ACMO via walkie talkie
• Once issued red flag status is communicated to all the ringside physicians at the venue, the chief or assistant medical office at the venue, the concerned Commission officers at the venue, the concerned inspector and the EMS staff at the venue.
• The combatant while at the venue is closely observed and monitored by the ringside physician(s)/ assigned inspector at a designated area-usually it is the Commission Room.
• Serial neurological checks are carried out.
• If any change in neurological status (decrease in GCS)/ development of new s/s-combatant transferred to nearest Level I trauma center via onsite ambulance (NO PROMOTER OR SELF TRANSPORT ALLOWED).
• The combatant is not discharged from the venue until additional medical consideration and consultation among the ringside physicians and the chief/assistance chief medical officer.
• Management is on a case to case basis with some combatants meriting discharge from the venue after neurological evaluation and medical clearance by the ringside physician (s). Others merit transport to the nearest level I trauma center for CT scan head and further care as deemed necessary by ER. Transport to ER in such cases will be achieved via on site ambulance and not via combatant or corner’s personal vehicle or public transport.
Click here to view the story and interview.
Click here to read Dr. Nitin Sethi's letter to the Editor-in-Chief of the Clinical Journal of Sports Medicine.
Fighter Handout on Dangers of Improper Weight Loss
At the request of the CSAC, the ARP has developed a handout derived from our consensus statements and other materials, geared specifically for the combat arts athlete, available for use by any commission or jurisdiction. Click here to download.
Dr. Nicholas Rizzo interview by Popular Science on Dangers of Improper Weight Loss. Click here to read the interview.
Click here to read the statement, published in the British Journal of Sports Medicine
Dr. John Neidecker was interviewed by Stephania Bell on her ESPN podcast “Answering the Bell” on the topic "Concussion Management in Combat Sports." The interview was based on the recently published “Concussion Management in Combat Sports: Consensus Statement from the Association of Ringside Physicians” in the British Journal of Sports Medicine, July 2018.
He discussed the challenge of managing concussion management in combat sports. “We need to be more stringent in our protocols and what we do compared to what a non-contact sport would do.…The intent of the sport is head contact…Concussion management in combat sports needs to be held to a higher standard.”
Click here to listen to the podcast
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