Monday, June 27, 2011

Medical Question: Scope of Practice

Elaine asks:
I have some medical questions from my WIP. I have a character who has had multiple concussions from past sports (ice hockey). I wondered if concussions are considered a "traumatic brain injury"?
Also, or along with the above, I have the hero suffering a fall at a remote location in Hawaii on some lava rocks which leads to possibly another concussion and a dislocated shoulder. My heroine, who is an athletic trainer, arrives on the scene and I thought it was reasonable to assume that she could try to reduce (is that the right word?) his shoulder since there is no way for help to arrive, i.e. no one else on scene and no cell phone reception plus a 30-minute hike back up to the road where her car is. Is it reasonable to assume that with his help they get to her car and she takes him to a minor emergency clinic who will probably send him to an actual emergency room for x-rays, or more tests? Also, that he might not show signs of any disability or impairment from the concussion until later?
Jordyn says:
Yes, concussions are considered traumatic brain injuries.
 3. News piece looking at testing post concussion. What you'll find in patients who have had a lot of concussions can be learning disabilities, headaches, issues with balance to name a few. Sometimes, symptoms suffered post head injury are termed post-concussion syndrome.

As far as the question concerning your athletic trainer, I think it would be outside her “scope of practice” to try and reduce (yes, that is the correct term) a dislocated shoulder.

Most often, the patient will be splinted in a position of comfort and sent to the ED. General ED management, depending on the type of dislocation, is to take an x-ray (sometimes a pre-reduction x-ray is not done), IV placement, IV medication for pain/relaxation, the reduction is complete and stabilized--- for the shoulder this is typically a sling/swath. Then post-reduction films are taken to ensure that everything is back in place as it should be.

One instance I could see this trainer attempting the reduction would be if there were problems with perfusion to the hand. For example, it's numb (this would be worrisome for nerve entrapment, compromise), it's pale or purple (which would suggest poor blood flow). This may actually be good for your fiction because it would be great internal conflict for the character. She's performing a procedure outside her scope of practice but to help her friend lessen his chances for permanent damage. If you choose this, I would make it clear to the reader it's outside her scope of practice but she's willing to take the risk and consequences of doing the procedure.
Actually, this question started to intrigue me and I started looking up athletic training protocols to see if it was a possibility. I found one from the University of Georgia--- read it. It does outline a scenario like the one I describe above with some qualifications of the person who may be allowed to try.
Any other suggestions for Elaine?
Elaine Clampitt is currently melding her passion for writing and ice hockey into a series about women in the world of professional ice hockey. She owned her own business which manufactured women’s apparel and has been able to continue to fulfill her love for numbers as treasurer of various organizations. An “empty-nester”, Elaine enjoys encouraging others in their writing and going to as many Avs games as possible.  This is her second year serving as the Secretary/Treasurer for Mile High Scribes, the ACFW South Denver chapter. You can find out more about Elaine at her websites:,


  1. Hi Jordyn,
    You covered a lot of good stuff here. Just a question regarding concussions. It's a bit late to be asking this since my first book is out. But how did they know if someone had a concussion during the time period I write, which is Regency England. That's approx. 1801-1820. And now I have to go back and read about poisons.:)

  2. Hi Jordyn,

    Would it be okay to list you as a go-to for medical questions on my writing blog, perhaps point to one of your posts as an example?

  3. Absolutely! Any support I can get would be great. Medical questions can be e-mailed to