SPORTS MEDICINE CAREERS

cover the event, for all eventualities. Whose role it is to provide you with this equipment is something you need to discuss at length with your club or NGB. Ideally, the club should provide the equipment you require, and you should state what you might need if your NGB does not mandate or recommend it. Then it becomes your responsibility to check that the equipment is present when it counts. It is no defence in a court of law to state: “I thought the equipment would be there”. Some NGBs do mandate what equipment should be present and police these rules, but this will depend on the specific sport. Some require more, others less. As boy scouts say: “Always be prepared”.

A big “part” of the equipment is

your skill to deal with the incidents that arise. You have accepted this responsibility, so make sure you are adequately prepared and trained to deal with things. In some instances, and at certain levels of sports, some sports clubs are highly unlikely to have adequate funding or facilities for housing a fully equipped medical room and providing all the mandatory equipment. One such example would be a Saturday afternoon amateur league. However after you conduct your risk analysis of a particular event, you might discover that all you require are your up-to-date qualifications, a pocket mask, tape, scissors, hot and cold running water, a blanket and a mobile phone (to call 999). Should a major incident happen, you will conduct your A–E assessment and, if necessary, keep the player still or use a manual in-line stabilisation (MILS) manoeuvre if you suspect a cervical spine injury, while you wait for further help in the form of an ambulance. Your NGB or team may have mandatory rules on minimum standards of equipment. Do you need to check it is all present and in working order before the day’s event kicks off? You should, because it is your responsibility. If you don’t, and an incident occurs, then what is your defence? Consider the scenario of a player who requires oxygen. You may well be carrying your oxygen bag with you, but you may have failed to check whether the canister was full. Worse still, you may have left the oxygen bag and its contents in your car. Your player requires 10 minutes of oxygen at 15

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litres before the ambulance crew arrive, but the canister is empty – or not present. Is this life threatening? Maybe not. It may simply help the player calm down and recover more quickly, but he or she will survive.

But what about a more serious

scenario? Another player has suffered a fracture to his spine at C3. He is fast losing his drive to breathe, but the oxygen bag is not present. You have no oxygen to give him and no bag-valve mask to assist with his ventilation. You do have cervical spine control and assistance, but now you will have to provide mouth-to-mouth unless the ambulance arrives immediately. Your need for that oxygen bag is now far, far greater. You might ask yourself whether a cervical spine injury is likely to occur in sport. And the unanimous answer is Yes. Only rarely, perhaps, but it does occur. So you must be prepared!

There is much more to think

about here. A spinal board may not be something you would ever consider using for a C3 complete injury as in this scenario. You feel that moving him once is quite enough. You will maintain his airway with cervical spine control, assist his ventilations and keep him warm while you wait for the emergency services to arrive. He will be moved just the once into the air ambulance. But maybe it is only a suspected cervical spine injury, which you cannot clear because the player is concussed. It is mid-February, the skies are full of snow and the temperature is down at 4°C and getting colder by the minute. You need to remove that player from the field of play. Are you prepared to do so? Do you have the appropriate number of people to help? Have you trained your stretcher-

BOX 5: THE IDEAL RANGE OF EQUIPMENT

n Spinal board (with head blocks and straps) n Spider harness n Airways (selection of) n Pocket mask n Stiff neck collars (selection of) n Automated external defibrillator n Full oxygen kit n Gloves n Bleach solution (for blood spillages) n Splints and crutches n Mobile phone n Blanket n Umbrella

bearers so that their manoeuvres are safe and professional and appropriate for the dismal weather? Are you and your helpers trained in emergency extrications? Can you use a spinal board? What about head-blocks, spider straps and cervical collars? More importantly, have you practised together and maintained your skill levels specific to such an event? We all know this sort of thing may only happen only once every few years, but when it does you must be prepared. At an event or game there will probably be other people you can call on for assistance, but what about during training? Are you prepared in this situation too? Afterall, your athletes will be training several times a week, far more than they compete, so you should also be prepared for an incident here, too. Your preparation for a training event is just as important as for a competitive event, and it requires just as much input with respect to risk analysis, planning and equipment.

PRE-HOSPITAL EMERGENCY MEDICAL MANAGEMENT

In the UK, there has been training in pre-hospital immediate care for pitch-side doctors and physiotherapists for a number of years (7). There are differences between the courses, regarding their credibility and selection of instructors and they vary widely in different sports. There are also differences in the standards that each course aims to achieve.

Some courses are at an advanced

level and are sports-specific. These include the: n RFL’s (Rugby League’s) Medical

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