Mike Healy – Pitchside Care CPD – Injury Rehab Network Event
The expert guest speaker for the Injury Rehab Network January event was Mike Healy who kindly provided a presentation about pitchside care.
Mike Healy is the founder and Managing Director of Sports ER International Limited, a UK-registered company that provides sport-specific, ‘fit for purpose’ education and training in pre-hospital emergency care, and consultancy on risk assessment and medical emergency action planning related to the sports environment. Sports ER have delivered courses and workshops in medical emergency management in sport for professional sports organisations and academic institutions in Barbados, Egypt, England, Iceland, Ireland, Italy, Qatar, Saudi Arabia and Switzerland.
He has 25 years of clinical experience working in a pitchside and courtside setting in professional football, rugby union and basketball. For 15 years he worked at the English Football Association and from 2009-2016 was Head of Medical Education and responsible for the strategy, development, and delivery of a suite of medical emergency management courses from elite professional to the grassroots level. In 2012 he was a Doping Control Station Manager at the London Olympics.
He is a skilled specialist instructor who has personally directed and delivered over 175 high-level courses to more than 3000 medical practitioners; the majority of whom work in elite sports. Mike is also a lecturer at the University of Birmingham (MSc SEM programme) and at the University of Central Lancashire (BSc Sports Therapy programme).
This in-person event, at Steroplast Healthcare in Manchester, was delivered in partnership with the Sports Therapy Organisation (STO) and was attended by ten of their members.
Mike guided us through an insightful session that focused on the management of medical emergencies in sport addressing the essential topics of clinical governance in sport, the initial assessment of the athlete, and the assessment of musculoskeletal injuries and its application in the on-field decision-making process.
To put things in perspective Mike presented an overview on the ‘rehabilitation pathway’ of the injured athlete from the acute phase of injury to the functional rehabilitation phase and subsequent return to sport, with a focus on the critical initial phase of assessment and management of the athlete.
Within the acute phase a traffic-light system was illustrated:
RED = life-threatening medical conditions and injuries
AMBER = serious illnesses and injuries
GREEN = minor injuries
Clinical Governance in Sport
Mike referred to the need for sports clubs and the medical practitioners therein to fully understand the legal issues and principles relevant to service delivery. More specifically that they need to facilitate and ensure the delivery of effective, ethical clinical practice and the maintenance of clinical standards that promote high standards of care and quality service. Policies and procedures should be fully integrated into the workplace to ensure effective practice in relation to the following domains:
- Establishing and maintaining competence
- Applying a duty of care
- Gaining consent
- The dispensing of medicines and administration of medical gases
- Maintaining medical confidentiality
- Having appropriate professional insurance
There is no place for a “token medic” at a sports event or on the training ground; the pitchside emergency care practitioner has a professional responsibility to limit their practice to areas of ‘established’ and ‘maintained’ competency. Professional indemnity insurance will only be valid if the individual is specifically educated, trained and competent in areas in which they are working.
Before the achievements of a Club, the health, safety and welfare of the athletes must prevail above all other considerations. ‘Medics’ must not put sporting outcomes before professional obligations. Practitioners will be held accountable for their actions; there will be a legal liability should an athlete suffer personal injury as a result of mismanagement. Mike described how in a court of law the question that would be asked in relation to an individual’s performance is “what would a prudent, reasonable person with an equivalent level of knowledge and training in the same role and with the same responsibilities (their peers) have done in the same circumstance?” Practitioners will not be found to be clinically negligent if they act and provide a standard of care that is in accordance with (and does not fall below) practise accepted at the time as proper by a contemporaneous responsible body of medical opinion. Importantly, practitioners should have an appropriate level of professional indemnity cover to protect against liability, loss or damage that might be incurred should the legal outcome found not be in their favour.
In terms of treatment consent, Mike explained that this should usually be addressed at the initial screening of the athlete when they enrol with a club. However, in an emergency situation, consent is ‘implied’ and presumed to be given, even for a child with a life-threatening condition when the consent of a parent or legal guardian cannot be immediately obtained.
The need to maintain strict confidentiality of athletes’ medical status, particularly in this time of seemingly unrestrained use of social media to circulate stories of ‘public interest’, was emphasised.
Medical Emergency Action Planning
Mike explained Sports ER’s use of the acronym ‘PERFECT’ (©Sports ER) to illustrate a useful way to remember the key elements which are associated with medical emergency action planning and are central to the optimal emergency medical care of the athlete:
- P = Personnel
- E = Equipment
- R = Records
- F = Facilities
- E = Environment
- C = Communication
- T = Transport
emphasising that “the right outcome requires the right person, with the right knowledge, skills and understanding, and the right equipment, in the right place, at the right time” (©Sports ER).
Initial Assessment and Management of the Athlete
Whilst recognising the universal, much-used underlying principles of assessment and management of the Airway, Breathing, Circulation, Disability and Exposure (ABCDE) to assess and treat the critically ill or injured patient, Mike emphasised the need to appreciate that the assessment and recognition of a potentially significant medical condition or injury may precede actual contact with a casualty. Utilising the principles of Mechanism of injury, Safety, Catastrophic haemorrhage, Convulsions, Cervical spine and Responsiveness (MSCCCR – ©Sports ER) it was advocated that these elements need to be considered and addressed sequentially and in advance of, or if feasible in conjunction with, the ABCDE assessment and management of the athlete. The athlete also needs to be in a ‘manageable position’, “a position in which they can be fully controlled, assessed and able to receive any necessary immediate treatment without the requirement to move them into another position. (©Sports ER 2016)”
The fundamental principles of assessment and management of the athlete that were expounded were:
– Use of the MScccR ABCDE approach to enable the detection and prioritisation of life-threatening conditions
– The need to look for and deal with the obvious, immediate or potential threats to life first
– The first rapid “look, listen and feel” of the athlete should take about 30 seconds, which will often indicate if the athlete is critically ill and in need of urgent help
– A complete initial baseline assessment (vital for trends) should take no more than 2 minutes!
Medical Equipment Kit List
The need for a range of medical equipment to address the management of potentially life-threatening conditions, taking into consideration items that are suitable for use in both the adult and paediatric athlete, was discussed and illustrated, including:
- Nitrile gloves
- Trauma shears
- Suction device
- Magill forceps
- Airway adjuncts
- Pulse oximeter
On-field Assessment of Musculoskeletal Injuries and Clinical Decision-Making
The use of the acronym ‘SPORTS ER’ (©Sports ER) in the on-field assessment of musculoskeletal injuries and its application in making ‘rest out’, ‘referral’ or ‘return to play’ decisions was explained; with the structured, sequential, step-by-step process being undertaken as follows:
- Player responsiveness
- Range of movement
- Tension tests
- Stand up
- Return to play
Following any incident, the importance of reflecting on one’s performance, record keeping and replenishing resources and equipment was also emphasised.
To conclude the learning from the pitchside care CPD session Mike summarised the following points and the need to:
- protect yourself – legally
- understand the sequential priorities when assessing an unconscious athlete and the need for immediate interventions
- follow a structured process when evaluating a musculoskeletal injury – active movements precede passive movements!
Follow Sports ER
For more information about ©Sports ER and their medical emergency management in sport courses and services click here.
Injury Rehab Network Events
The schedule of Injury Rehab Network events delivered in partnership with BASRaT for 2022 is growing with exceptional guest speakers from the field of sports medicine and rehabilitation. Find out more and register your interest
Future Event Details
- 3rd March 2022 at 7pm – Michael Blackie BDS (The Park Practice) – register here
- 14th April 2022 at 7pm – Steve Kemp (Lead Men’s Physiotherapist England Senior Football Team)
- 19th May 2022 at 7pm – Tom Parry (Head of Performance Nutrition, Manchester City FC)
- 14th June 2022 at 7pm – Dr Andrew Newton (Consultant in Emergency Medicine)
- 7th July 2022 at 7pm – Dr Carl Todd (Consultant Osteopath in Sport & Exercise Medicine)
- 20th September 2022 at 7pm – Dr Monna Arvinen-Barrow (Chartered Psychologist & Associate Professor University of Wisconsin-Milwaukee)
Read more about the programme of events for 2022 and register your interest here.
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