expertise. You work well as part of a multidisciplinary team. You like working autonomously. You enjoy reasoning and decision making. You work well under pressure. And you enjoy sport. You are presented with an ideal opportunity to use your medical skills alongside your passion for sport, by being offered the chance to work with a group of athletes, assisting in their preparation to train and compete to their maximum ability. Your input could be instrumental to their success.

ACCEPTING THE ROLE It is now Saturday afternoon. You are the young therapist on the spot. You’re thinking: I have my qualification. I have a pair of scissors in my pocket, some strapping in my bag and some ice for the injuries that are bound to happen. Or you are the young doctor on site, and you’re thinking: I have all these skills in my head. I have a bag with some suture equipment inside and a few anti-inflammatories. You are both ready to discharge

the role you have accepted. But hold on a minute. Are you really ready? Here are just some of the things

you need to consider when you accept this kind of role: n Your duty of care n Roles and responsibilities of clubs, venues and sporting bodies

n Medical records and confidentiality n Medical equipment n Pre-hospital emergency medical management.

Your duty of care First let us discuss your “duty of care”. In accepting your role to work with athletes at any level or in any age group you have taken on a significant responsibility. Whether you get paid for that role at your current level of employment is irrelevant. What matters is that the acceptance of a ticket for the event or a car-park pass is proof enough of a contractual agreement and thus you are bound by your duty of care. It goes without saying that you

must have medical indemnity insurance to cover you for this role. This is outside your other medical roles and it is incumbent on you to check with your insuring body exactly what you are covered for, both within the UK and abroad. We are very aware, in these litigious times, of events in which

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BOX 1: LEGAL CASES YOU SHOULD KNOW ABOUT

n Watson vs British Boxing Board of Control (2001) QB 1134

n Brady vs Sunderland AFC and Boobis & England (1998) CA (unrep.)

n Bolam vs Friern Hospital Management Committee (1957) 1 WLR 583

n Bolitho vs City Hackney Health Authority (1997) 4 All ER 771

our peers have come under scrutiny – remember the case of Watson vs British Boxing Board of Control, for instance (see Box 1). Some have been found negligent because they did not have the skills needed to carry out their duties, which they accepted. The truth is, you will always be judged according to what your peers would do in that situation – this is the Bolam test. The Bolam test measures whether a person has discharged his or her standards of care in managing a patient or athlete. It is applicable to all health professionals and is not restricted to doctors. The test was developed through a series of English cases, which culminated in Bolam vs Friern Hospital Management Committee, forming part of English Tort Law. Since that time it has been refined, but in general it is strictly applied and can succeed if a patient shows that the practitioner practised in a way that the rest of the medical profession find unacceptable. Now, just what are your

responsibilities to the crowd? Do you have any? Generally the answer to that is a resounding No. There are guidelines about safety at sports

grounds (1) that are already in place. They follow the lines of the Taylor Report and every sporting ground must abide by them. They clearly outline the number of first-aiders required at each event, when a “crowd doctor” should be on-call or present, and when an ambulance officer and crew should be around, depending on the size of the crowd expected at the event. If you are the doctor or therapist for the team, then your role is with that team, as well as the match officials, and possibly the visiting team if they have no medical staff with them. Your responsibility is not for the crowd. You cannot accept responsibility for both. You might wonder what the role of the ambulance is. In the majority of sports (there are some exceptions) the ambulance crew is present for the crowd, not to assist you on the field of play. Some crews will happily assist you if a major injury occurs and call 999 backup for the crowd. Others will call an ambulance for you, while sticking to their ultimate role. Remember, though, that even if the ambulance crew assist you, the athlete is still your patient and you are still the primary carer – so the responsibility is yours. What of the amateur event,

with a crowd of only a few hundred people, where an ambulance is not

COMPETENCIES AT ALL TIMES AND DISCHARGE YOUR DUTY OF CARE RESPONSIBLY

BOX 2: CROWDS AT SPORTING EVENTS

n Check whether your role includes responsibilities for the crowd.

n Do you have crowd cover medical training and indemnity insurance?

n Have you made your presence known to the first aiders present for the crowd and outlined individual responsibilities?

n Is there a medical room available to take patients to?

n Does the ambulance have access to the ground if required?

sportEX medicine 2010;46(Oct):17-22

WORK WITHIN YOUR OWN PROFESSIONAL