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SPORTS MEDICINE CAREERS


required? There is a crowd doctor on call according to Health and Safety Executive legislation – if the club is abiding by the rules. Should an incident occur in the crowd, do you now have a role? Technically the answer is still No – but morally it might be Yes. First-aiders should be present at


such an event, usually the St John ambulance service is at most events. Clubs make a donation to St Johns and they send a suitable number of first- aiders together with various pieces of first-aid equipment. They can deal with most scenarios. But what if the event is only for the local pub team, or a mini- league game with no true stadium? What if a serious incident occurs in the crowd and is brought to your attention? Let’s assume you are the only doctor or physiotherapist in the vicinity. Now do you have a duty to respond? No. You do not have a duty if your


employment is strictly for the team. Unless, of course, you are employed as the “first-aider”! Of course, morally (arguably ethically) you will probably want to assist, especially if you are aware that the crowd is made up of parents, children playing, family, friends and bystanders with little or no first-aid provision. The principle Duty of Care is owed by the club or venue or other host, and is “owed” to everyone on its premises – athletes, officials and spectators alike. So if there is any delay in delivering treatment, or mistreatment of anyone there, then the law would not distinguish between whether he or she (the victim) was a participant or a spectator. Either way, the club would be sued for negligence. If you are the sport and exercise


medicine healthcare professional (SEM-HCP), acting as an officer of that club or team or venue, then the Duty of Care could be said to be “owed” vicariously. Failing to respond to an incident in the crowd could (in the absence of St John’s) still be in breach of the duty of the club or team or venue and could be pursued legally. Aside from the legal implications, there is also the professional angle. A doctor or nurse, for example, who failed to respond would be in breach of their specific obligations (to the General Medical Council and the Nursing and Midwifery Council, respectively). The Chartered Society of Physiotherapy (CSP) says that a physiotherapist must never act to bring the profession into


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disrepute. Thus, failing to attend to a seriously ill person in the crowd may result in professional disciplinary action in the known absence of appropriate first-aid cover. The “Good Samaritan” principle


covers medical professionals when first aid is provided that is not in exchange for any reward or financial compensation. However, you would not be covered under this principle if, for example, you were providing first aid under your terms of employment. In the United States there is Good Samaritan legislation (2) in place in various states, but in the UK there is no Good Samaritan law. The principle does not guarantee protection, anyway, because as soon as you step forward, you assume a “duty”, and therefore you are required to deliver a “reasonable” level of care (3). If, as an officer of the club, crowd cover is part of your role then you will have been expected to risk assess your extended responsibilities. Remember, if you are going to leave your duty of care to your players in order to attend to some crowd emergency, you must stop the game or event first, otherwise you are neglecting that duty! Please refer to the following publications for further reading on this matter (4–6).


Handing over your duty of care Care should also be taken with respect to “who” you hand your care over to. Once an NHS ambulance with a paramedic crew arrives you know the athlete is in good hands, but what if that crew is not a paramedic ambulance crew bound by the Health Professions Council? What if it is a private company and crew hired for the event? Do you know their qualifications? Can you be certain you have clearly discharged your duty of care? If not, then don’t hand over responsibility until you do know. Make it your business to know who you are working with, preferably before an event, and never in anger! After all, if you hand over to someone who holds no medical qualifications and thus no medical indemnity insurance, and an incident should arise while a player or athlete is in their care, then who will be litigated against? The answer is you! And you should know better, because you had the duty of care!


ROLES AND RESPONSIBILITIES The National Governing Body (NGB) or sporting team also has a duty of care. One duty may be in the provision of first aid and medical support to the athletes in its care. Regardless of their duty, and your own, it is incumbent on you to know what your roles and responsibilities within the NGB or team are, so that you discharge them effectively and there is no comeback. The NGB or club you work with also has responsibility here, to check your qualifications and ensure you are appropriately qualified. Whether they have a duty to provide you with the continuing education you require to keep abreast of that role is another question (and one you should take up with them!). Here are some key questions: n What responsibilities do you have within the club? n Do you know exactly what they are? n Do you have a contract in which they are specified (and if not, why not)? n What are your roles?


EVENTUALITY THAT YOU CAN REASONABLY EXPECT TO OCCUR


BE PREPARED FOR EVERY


BOX 3: KEY POINTS ABOUT YOUR DUTY OF CARE


n You are bound by your duty of care n You must have medical indemnity insurance n You will always be judged according to what your peers would do in a situation


n You may be judged by the Bolam test n You are responsible for the team if you are the team doctor or therapist


n Your are not automatically responsible for the crowd (but there are important exceptions)


n You are not necessarily covered by a Good Samaritan principle


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