By Sarah Leggett, GoDuke the Magazine
Assistant athletic trainer Tara Moore recently identified a flaw in the NCAA men’s soccer rule book and immediately took action when a Duke player’s medical condition brought up red flags.
Moore came to Durham in 2015 from the University of Alabama, where she served as a graduate assistant athletic trainer, after graduating with a degree in athletic training from the University of Southern Maine in 2013. As an undergraduate, Moore was a member of the women’s soccer program and knows the game inside and out, including the rules.
“The rule in soccer is once you come out of the game in the first half, you’re not allowed to re-enter the contest,” Moore explained. “Once a player comes off the field in the second half, you’re allowed one re-entry … for any reason. The two exemptions are if you have blood on you or if you are suspected to have a head injury.”
With concussion protocol in today’s spotlight, the referees are trained to look for any sort of contact that could cause head injuries and can send players off the field if they see fit. However, like Moore mentioned, those are the only two scenarios, no matter the situation, that will not result in some sort of penalty.
“We had a student-athlete join our team last year that was sickle cell trait positive,” Moore said. “Sickle cell trait is a congenital disorder where your red blood cells are shaped normally and you’re healthy, but under extreme conditions such as exercise, stress, heat — essentially everything in athletics — their red blood cells are missing a component that causes them to deform to a sickle shape and they can clot. That clotting causes tissue death.”
Many of the symptoms of a sickling crisis are similar to that of a concussion. The athlete would report feeling lightheaded, dizzy and that their muscles are cramping.
“Unlike a true muscle contraction cramp where you can see or feel the muscles contracting, the muscle is actually soft and supple,” Moore said. “They feel like it’s cramping, but what they’re feeling is the pain of that restricted blood flow.”
A few years ago, the NCAA began mandating that every student-athlete would be tested for sickle cell trait. Prior to coming to Duke, the student-athlete mentioned before was unaware he was sickle cell trait positive until he was tested.
“We have a lot of policies here at Duke and through the NCAA where we educate the individual on what it is, what to look for, what the symptoms are, how we treat it and how we care for it,” Moore commented. “For example, we don’t allow any student-athletes who are sickle cell trait positive to do any timed conditioning tests because in the last decade, there have been about 10 deaths in NCAA athletics from sickle cell. It’s actually, in some sense, less common of course than concussions but is more dangerous.”
Moore sat down with the student-athlete and coaches to go through all the paperwork and educate them on what to look for and how to report it. Now knowing he was sickle cell trait positive his entire life and fortunately never having had any issues, the student-athlete was feeling very apprehensive about reporting any symptoms he might experience.
“The only way for me to determine if he is in a sickling crisis or if he’s physically cramping is to do an evaluation on him and be able to feel if the muscles are contracting,” Moore said. “If he is in a sickling crisis, you have to act really quickly — getting them out of whatever current conditions they’re in, stop exercise immediately and administer oxygen or, like I said, it can be life threatening.”
Prior to the first game of the season, Moore admitted she was worried the student-athlete wouldn’t report any potential symptoms because if he did, the freshman starter wouldn’t be able to re-enter the game.
“Prior to this student-athlete arriving, we had cases when visiting teams, even teams in the ACC, had student-athletes with sickle cell,” Moore said. “We would prepare with oxygen and let EMS know ahead of the game with our treatment plan. Basically, if I needed to treat someone, the student-athlete and myself shouldn’t be restricted via this rule.”
That’s when Moore took all of her knowledge and experience and put a plan into motion.
“This is a life-threatening issue and this has to be something I can evaluate without him being penalized. There shouldn’t be any reason for him to not want to report something that is as serious as this. If coaches, referees, players, etc., are being educated on concussion protocol, they should also be aware of this other condition that they’re going to see throughout the year.”
The Duke coaching staff put Moore in touch with a head referee to explain what sickle cell trait is, how to manage it, what to look for on the field and her concern regarding the substitution rule. Moore cited the rule book for concussions and blood as those are exempt while this condition is far more life threatening than if there is blood on a jersey.
“He was great,” Moore said. “He responded right away and basically said he had never heard of this before and asked me to put something together and he would make sure all the referees got the information and were knowledgeable on which player it was.”
Moore worked alongside Todd Mesibov, Duke’s associate director of athletics/compliance, to continue to push for a rule change. Moore contacted the commissioner of the ACC, John Swofford, and within the next 48 hours, he had emailed all of the coaches in the league and added sickle cell trait to the rule, effective immediately.
“The NCAA came back and said, ‘The ACC doesn’t have the power to make a rule change,’” Moore said. “This was discouraging and frustrating because the only reason this student-athlete knew he had sickle cell trait was because they created a great rule to mandate this testing.”
Moore teamed up with Hap Zarzour, Duke’s executive director of athletic medicine, to further gain knowledge and support to rally behind a rule change.
“Hap helped me bring this rule change to the other directors around the conference and got them on board to advocate for it,” Moore said. “We also looked at what other sports have restrictions for medical timeouts or medical injuries. I work with women’s tennis as well and it’s similar in that they’re allowed one medical timeout per match for one injury. So, if I have two minutes to evaluate and three minutes to diagnose someone, but I have someone who is sickle cell trait positive, by putting a time restriction on an evaluation, you’re discouraging someone from reporting symptoms or an injury. So, we looked at that and we said that congenital things like diabetes, sickle cell trait and other potentially life-threatening diseases need to be exempt from any substitution rule or injury evaluation rule. Finally, the NCAA came back and said, ‘That makes sense, we’re going to change it.’”
The new rule is in effect for both men’s and women’s soccer and all that needs to be done prior to a game is have a physician write a letter stating the student-athlete’s medical condition. Now, the student-athlete can come in and out of the game without penalizing the athlete or the team.
“Tara did a great job of laying out the problem, potential consequences and reasons it was important to change the rule,” Mesibov said. “She was able to get things changed fairly quickly compared to what is normally a very lengthy process.”
Moore says she hopes this change will eventually translate across all sports and says she’s already seen a change among fellow athletic trainers.
“At the end of the day, that’s our job,” Moore said. “We’re here for the ankles and the knees and all of that type of stuff, but we’re medical professionals who are trained in emergency situations and those are the things that we really need to be on top of and advocate for our athletes. That’s part of our job, to recognize things like that and make sure that their safety is the number one priority.
“This situation has sparked many conversations to make sure our emergency action plans are in place and we’re prepared and know what we’re doing in any scenario. We made some changes to our health form because of this. If we have a student-athlete that is adopted, they may not know their family history or medical history, because some of these conditions are congenital and hereditary. Hopefully this rule change will spread to other sports.”
For her efforts, Moore was chosen to receive a Meritorious Service Award by the university as part of the annual Presidential Awards, presented each year to recognize staff members who have distinguished themselves through outstanding service.
“It’s definitely really exciting and I’m really, really humbled and honored,” she said. “It meant a great deal to me just to be nominated by Hap. He’s awesome and he does a great job of supporting us and our endeavors and recognizing how hard we work as a department and all of us — we’re trained medical professionals who are there, first and foremost, to deal with life threatening medical situations. I invited everyone on our staff to the award ceremony because this is important for not just me, but for all of us. This isn’t anything different than any one of us would have done for their student-athletes. I’m very excited about this and for all of us — it definitely feels good.”