US Pharm. 2010;35(7):8-15.
The pharmacist has always been a frequent source for patients to receive counseling in regard to minor health care problems. Some of these ailments are seasonal in nature, such as seasonal allergic rhinitis. Other seasonal health problems include those that are more commonly encountered during the summer months. Examples are insect stings and bites and injuries incurred as a result of participating in summer sports.
Which Summer Sports Are the Most Dangerous?
The American Academy of Orthopaedic Surgeons (AAOS) once carried out a campaign entitled, Prevent Injuries America.1 A linchpin of the effort was the AAOS ranking of specific summer sports or recreational activities and the estimated number of yearly injuries caused by each. AAOS created the ranking using data from the U.S. Consumer Product Safety Commission. The top two offenders were basketball and bicycling, each causing 1.5 million or more injuries yearly. The next three were baseball, soccer, and softball, each responsible for almost half a million injuries yearly. They were followed, in descending order, by trampolines (246,875 injuries), inline skating (233,806), horseback riding (196,260), weight lifting (189,942), volleyball (187,391), swimming (149,482), wrestling (136,055), roller skating (115,763), and gymnastics (86,479). While not included on the list, golf is also dangerous, causing perhaps as many as 132,000 injuries yearly.1
A similar list from the AAOS ranked children’s summer sports and their associated injury rates. The specific sports and their yearly injury rates were basketball (1,066,004), bicycling (832,775), baseball/softball (211,646), swimming (117,889), volleyball (92,409), inline skating (82,903), and tennis (20,514).2
Skateboarding is also a potential risk. A retrospective study over a 5-year period in the United Kingdom uncovered a host of skateboarding injuries.3 Victims were mostly males under the age of 15 years, with the most common injury being a fracture of the upper limb. A California study of skatepark injuries estimated that the average time lost from school and work per injury was 1.1 and 5.5 days, respectively, with estimated medical costs and lost wages totaling $3,167.4
Pharmacist Assessment of Injuries
What can community pharmacists do for patients who approach them with possible summer sports injuries? Pharmacists may initially inquire about symptoms of a fracture or dislocation, which include an out-of-place or swollen limb or joint; intense pain, numbness, and tingling; limited mobility of, or inability to move, a limb; or the presence of swelling, bruising, or bleeding.5-7 These patients require an immediate referral.
Engaging in assessment beyond the simple questions above is controversial at best for community pharmacists. Some colleges of pharmacy include coursework or laboratory exercises training students in the rudiments of assessment. They may be trained to use otoscopes, ophthalmoscopes, and reflex hammers. The express purpose of assessment using this equipment is to gather the information necessary to reach a diagnosis. Faculty members should question these exercises for several reasons.8 First, the general medical community at large does not consider pharmacists to be diagnosticians, an opinion shared by boards of pharmacy. In fact, state pharmacy practice acts usually specifically prohibit attempts at diagnosis. Thus, there is no meaningful reason for the community pharmacist to engage in patient assessment, and to do otherwise may violate the state practice acts. Second, the typical community pharmacy does not have the equipment required for assessment, such as otoscopes. Third, community pharmacists are not allowed to ask patients to disrobe to the extent that a full assessment would require, nor do they have private examining rooms. Finally, pharmacy malpractice insurance only protects the pharmacist against malpractice while engaging in legal acts. The community pharmacist who desires to begin patient assessment must thus consider numerous issues before proceeding.
For these reasons, the typical community pharmacist must refer patients with anything other than the