Paul Lubas – The Pitch-Side Paramedic
Experienced Sports Paramedic Paul Lubas Recounts What it Has Been Like to be a Pitch-Side Paramedic
There have been massive changes in the management of on-field trauma since I covered my first major football match for the Welsh National football team in 2000. This came shortly after providing Paramedic pitch-side cover during the 1999 Rugby World Cup at the Millennium Stadium in Cardiff. I became a Paramedic for the Welsh National football team, covering games both in the UK and abroad and have provided pitch-side cover for all levels of Welsh football since.
In 1998 I was asked, by a small group of physiotherapists working in Welsh Rugby, to provide training in the immediate management of on-field trauma and spinal injuries. They were aware this element was missing from their training and yet a vital part of their responsibility on-field. I was grateful for this, as working with them gave me a greater insight into the role of the physiotherapist working pitch-side and invaluable when I was sat pitch-side in the Millennium Stadium. This also led to the development of the Sports Trauma Management course, which we continue to run today.
Although I was fortunate enough to have pre-hospital experience as a Paramedic, followed by 5 years working in a hospital as a Resuscitation Officer and teaching Advanced Life Support courses, I still felt like a fish out of water when I sat on the bench during the 1999 world cup. The noise of the 74,000 fans and the constant running back and forth of the TV cameras, technical staff and officials. This was an alien place for me to be working – I was also under the spotlight and imagining all the experts at home waiting to criticise any error I made.
Working pitch-side is clearly a specialist area for a Paramedic, who normally works independently or with one colleague on an ambulance. It is also very rare for a Paramedic to actually witness an incident, as you are normally responding to the aftermath. Having a medical team available to support when you arrive on the scene is another rare luxury.
Over the last 17 years, there has been great progress in the field of sports medicine. The groundsmen are no longer expected to carry players off the field on wooden stretchers, doctors are specifically trained in sports medicine and sports scientists dissect every aspect of the athlete’s performance.
Automated defibrillators have been developed and are becoming increasingly more accessible, particularly after the Fabrice Muamba incident. There is also a much greater awareness of the effects of concussion on players health and support to medical staff making decisions relating to a concussion, it has taken a long time to get here.
I have been fortunate to have worked for both Cardiff City FC and the Wales National football team at Cardiff City stadium where both teams currently play. I am seen with my team, as an integral part of the medical setup, which is so important if the most effective response is to be provided together.
During John Toshack’s reign as manager, the Football Association of Wales recognised the contribution of the technical staff and I received a Welsh Cap for my Paramedic services to the team.
The equipment used to manage injured players is not specifically designed for use in sport and the techniques and skills we use are adapted from the management of general trauma. Every incident is different and the most important skill needed in managing prehospital trauma is to be adaptable to the situation you are dealing with.
As far back as 1982 in the Ambulance Service, we used metal scoop stretchers to manage suspected spinal injuries. A device originally developed for moving bodies in a mortuary. With the introduction of the Prehospital Trauma Life Support courses in the 1990’s the ambulance service began using the longboard as the choice for the extrication of casualties and transfer to hospital. The management of suspected spinal injuries subsequently improved greatly. The use of old wooden canvas stretchers and metal scoop stretchers meanwhile continued in most sport including football. Training in the use of the equipment was poor and it was not unusual to see players, even at top level being carried off on a scoop stretcher the wrong way around or with a cervical collar applied upside down!
On our course in 1998, we taught the use of the longboard in the management of suspected spinal injury and the gold standard was to lift the patient onto the longboard using a metal scoop stretcher. We used this technique on a number of occasions, including an injury to John Terry in the Carling Cup final 2006. With the recent introduction of the ‘Scoop EXL,’ Ferno has re-designed the stretcher material and it has become the current method of choice for managing suspected spinal injuries. The stretcher allows you to reduce the angle required to log roll the player compared to the longboard and the player can also be scanned while remaining on the stretcher at the hospital.
The full body mattress is also an option to consider when immobilising a suspected spinal injury. The player is laid on the stretcher and the air pumped out, moulding the stretcher to the shape of the patient. One issue found with this technique is that the mattress has to be loosened completely if you later need to examine or attend to the player.
I am not sure where the use of basket/bucket stretchers in football has originated. These stretchers are designed for mountain rescue and I am yet to be convinced they have any use in football. They are heavy, bulky and difficult to load and remove a player. An injured player is often put in the bucket stretcher on a scoop stretcher adding time, unnecessary movement and extra weight.
I normally load a patient onto a scoop stretcher and either carry, with a trained team, a short distance to a wheeled (Stryker Rugged) stretcher pitch-side, or place the scoop on a wheeled stretcher on the field and wheel from the pitch if the injury is more serious.
Medical Team Training
Lubas Medical provide trauma training to members of the medical team and practice scenarios pitch-side along with match day medical staff at regular intervals.
On match days we always meet prior to kick off with the opposition doctor/physio and brief the resources available should a player get injured, including the availability of scanning facilities, ambulance and additional medical staff such as dentist and orthopaedic surgeon etc. It is also important to agree on the role of the physio and medical staff should a player get injured, including who will maintain manual immobilisation if required and who will lead the team. We also plan for the eventuality of two players being injured and how the team will separate to manage the incident.
We allocate roles prior to the kick-off including the lead paramedic, second paramedic responsible for the trauma bag, a team member responsible for bringing the scoop stretcher onto the field and a final team member with additional equipment such as splints and straps.
Our pitch response team consists of 2 Paramedics supported by 2 Nurses/EMT’s, who have all completed a Sports Trauma Management course. Working pitch-side is a specialist role and all staff need to be trained to respond effectively and use equipment that may not be otherwise immediately familiar. We also have an ambulance crew consisting of a Paramedic and Ambulance Technician. We observe the game from behind the dugout and the lead Paramedic has radio communication with the team physio.
My company (Lubas Medical) provides a dedicated front-line ambulance for the sole use of players and officials if required, this greatly helps in the continuity of care. The ambulance is also provided with our full team for all the Cardiff City FC development side games.
If a player receives a serious injury, our lead paramedic moves to the side of the pitch to observe and liaise with the medical staff. The three other team members will stand by the medical equipment placed pitch-side. The ambulance crew will be ready to bring the wheeled stretcher pitch-side or to the injured player as needed. The lead paramedic will join the medical team on-field if requested by the physio or doctor, followed by the rest of the team with appropriate equipment as required.
It is important that only medical staff who are required on the field, attend to the player. We have had situations where too many people have run on to the field and although trying to help, have just confused the situation.
After initial treatment and immobilisation on-field, the player will be transferred to the medical room where the team doctor and ambulance paramedic will work together to treat/stabilise the patient. There is no benefit in rushing into an ambulance without first stabilising and preparing the player for the transfer.
The pitch-side team are then able to return to the field and the ambulance crew will transfer the patient to the appropriate hospital for treatment/investigations.
After the incident, it is important to debrief the event with the medical team and identify any areas for future improvement.
We have come a long way in the development of on-field trauma management, although we still see still some very badly managed injuries, even at the highest level of international football. It will be interesting to see if a Paramedic team will be allocated to support all football clubs in the future and if this approach can help to improve the overall standard of care in the game.
For information about the training and services from Lubas Medical please see lubasmedical.com and for information about the Steroplast range of first aid and emergency equipment for sport please see www.sterosport.co.uk or call 0800 978 8301.
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