Summary
• Contact your medical
protection organisation concerning your individual position
and role in sports activities, your level of liability
cover and subscription
• Consider
the points outlined in these notes before undertaking a
role as medical officer to any sports club/event
•
Consider undertaking an appropriate training course and
obtaining membership of an appropriate specialty
association/organisation.
THE POSITION OF THE MEDICAL DEFENCE
ORGANISATION
The following information was taken from "The Medicolegal
Side of Sporting Events" BMJ Career Focus
2005;331:26 and is by Stephen Green, Head of Risk
Management at the Medical Defence Union
REGARDING INDEMNITY
•
We advise doctors to check
their indemnity position with their medical defence organisation before
undertaking their clinical duties to ensure they have appropriate
indemnity as this would not fall within the terms of acting as a
good Samaritan. Some professional sports bodies provide
indemnity for doctors attending events—doctors should check whether this
applies
• Medical Defence
Union (MDU) members not separately indemnified
can seek assistance with medicolegal problems
arising from attending sporting events in the United Kingdom and
Ireland, whether paid or as a volunteer, providing they are
paying the appropriate subscription
REGARDING
RESPONSIBILITIES
•
The MDU does not discourage
doctors from offering their services, either on a voluntary or paid basis, at
sporting events such as motor racing. However, incidents can
occur at these events in which there may be very serious
injuries to participants and spectators, and we would therefore
advise doctors to contact the organisers and the relevant sporting
association for further specific advice
• Doctors who attend sporting events are expected
to have appropriate
qualifications, skills,
experience, equipment, and support as well as expertise in areas such as
cardiopulmonary resuscitation, airway maintenance, and spinal fracture
immobilisation
• Check that equipment levels and clinical protocols to be
used at the event
conform to guidelines published by the relevant
professional and/or sporting
body and liaise with organisers to determine what support is
required
• If you are working as part of a medical team,
communication is an
important issue. Make
sure you discuss your responsibilities with your colleagues, as well as how to obtain a second
opinion
• Arrangements for transfer to hospital and documentation of
clinical involvement should be reviewed and understood by
everyone within the
team before starting
work
COMPLAINTS AND CLAIMS
•
A doctor may face a complaint
or claim if it is thought that he or she did not deal properly with an
injury to a spectator or participant. In the event of a claim,
a court would consider a doctor's competence, specialty,
training, and relevant experience
• A doctor needs to be able to show that the standard of
care provided was that
of a reasonably skilled and experienced practitioner
professing to have that
skill. He or she must demonstrate that there is a reasonable body of medical
opinion prepared to support his or her actions in a particular case.
THE POSITION OF THE BRITISH MEDICAL ASSOCIATION
Doctors who act
as medical officers at sporting events, whether under
contract, or in a voluntary capacity, and who have agreed
to act in such a capacity in advance of an event, may be
considered as private practitioners and as such, any care
offered to competitors would not fall within the terms of
acting as a ‘Good Samaritan’. However, if doctors attend an
event, in any capacity, including as a spectator, then it
is important to consider the advice of the General Medical
Council (GMC),2 "In an emergency, you must offer anyone at
risk the treatment you could reasonably be expected to
provide".
Considerations for practice
These
are general notes and each doctor is advised to contact the
appropriate sporting organisation for further guidance.
Doctors providing regular medical assistance should ensure
that they have:
♦
A basic
knowledge of the
sport, its
rules and its risks
♦
Knowledge of the
particular aspects of physique and fitness required to
safely participate at the appropriate level
♦
Knowledge of the
possible type, mechanisms and results of injury sustainable
in that sport
♦
Appropriate
knowledge, experience and equipment to deal with such
injuries to both competitors and spectators
♦
Knowledge of
resuscitation procedures, airway maintenance and spinal
fracture immobilisation and the ability to treat
anaphylaxis correctly.
Doctors should also, if appropriate to the
situation:
♦
Clarify whether
medical support covers competitors and/or spectators. At
all events the organisers or owners of the facilities
should have responsibility for arranging medical cover for
the spectators and providing medical equipment.
♦
Liaise with the
organising committee of the event/club at an early stage
regarding level of support required, roles and
communications; for example, if an event is spread over a
large area, communication systems will need to be
determined, ie possible use of radios and mobile phones.
♦
Undertake a thorough
risk assessment and, if appropriate, assess the level of
assistance required from other doctors, nurses or
paramedics which may be dependent on the number of
spectators expected. In events where over 2000 people are
expected, doctors should be fully conversant with the
statutorily required major incident plan and the role they
may play within it.
♦
Determine duties and
responsibilities. A doctor who delegates treatment or other
procedures, must be satisfied that the person to whom they
are delegated is competent to carry them out.
♦
Ensure that their
own medical equipment, and that available at the event,
meets the needs of the sport concerned.
♦
Liaise with
emergency services where appropriate – familiarisation with
local services if travelling outside known healthcare
systems, in case competitors require transportation to
hospital should a serious injury occur. Notify in advance the
ambulance and hospital services of an event from which
assistance may be required.
♦
Consider a plan to
deal with larger scale problems should they arise,
including crowd incidents.
♦
Consider influences
on competitors’ ability to perform safely, and where
possible be aware of any medication taken or medical
conditions, for example, whether the competitor is
asthmatic or diabetic.
♦
Be clearly
identifiable at any event to competitors and
spectators.
♦
Be aware of doping
regulations of the sport in order to recommend treatments
that do not contravene sports regulations.
These considerations should be in addition to having the
essential clinical skills basic to all medical
practice:
♦
Sound medical
knowledge
♦
Good communication
with patient and history taking
♦
Proper, relevant and
adequate examination
♦
Accurate record
keeping
♦
Doctor-patient
confidentiality.
Consent and confidentiality
♦
The general ethical
and legal rules concerning consent apply here in the same
way as in any other sphere of medical practice.
♦
If a person is
injured in a sporting event, any doctor should be ready to
offer assistance in an emergency. Patient consent should be
sought where that is feasible, but in an emergency it is
assumed that the patient has given implied consent unless
there is clear evidence to the contrary.
♦
Medical
confidentiality must be observed.
Performance enhancing drugs
The
GMC's Standards Committee holds the view that, "Doctors who
prescribe or collude in the provision of drugs or treatment
with the intention of improperly enhancing an individual’s
performance in sport would be contravening the GMC’s
guidance, and such actions would usually raise a question
of a doctor’s continued registration. However, this does
not preclude the provision of any care or treatment where
the doctor’s intention is to protect or improve the
patient’s health. This means that doctors would not be
precluded, for example, from participating in needle
exchange schemes." The BMA is currently undertaking a
separate
review of the use of drugs in sport and related issues.