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New York State Athletic Commission Red Flag Policy

April 03, 2019 3:48 PM | Lisa Nelson (Administrator)

• 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.


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