Responding to calls on the playing surface

There has been a lot of discussion on social media about Barnabás Varga, the Hungary footballer. On Sunday 22 June, he went down injured following contact with Scotland’s goalkeeper Angus Gunn. The Group A game, played at The Stuttgart Arena, was stoppped in the 68th minute to allow for the playing surface medical team to respond.

Critics have suggested that the medical team’s response to the 6-yard box on the playing surface was too slow. Hungary’s Captain Dominik Szoboszlai was seen grabbing the basket stretcher being carried by stretcher bearers and trying to run with it towards the injured Varga (source: The Mirror).

The Union of European Football Associations (UEFA) insisted the correct protocol was used throughout the worrying incident. UEFA said there was no delay in the treatment of the Hungarian forward. “The coordination between all the medical staff on site was professional and everything was done in accordance with the applicable medical procedures. There was no delay in the treatment of and assistance to the player.”

BBC’s Gabby Logan was forced to apologise on air, after the host broadcaster’s world feed included a replay of the collision. “We were as shocked as you when they replayed that incident. We were very surprised that UEFA chose to play in that replay, which is why we cut away to a wide angle as soon as we could.” (source: Football London)

Following a 6-7 minute pause in play, Varga, who wears the 19 shirt, was stretched off. He was then transferred to a hospital in the city.

Playing surface medical cover – how does it work?

Precisely who is allowed to be present on the playing surface, and even where they can go, is typically goverened as part of a sport’s rules. That could be a fixed number of players, their positions, the officials, team managers, and more. The rules may include the court surround, team benches, and other areas immediately adjacent.

Below those rules will often be a set of competition rules set out by a tournament organiser. As well as ensuring that play happens fairly, and safely, there could also be commercial considerations added here – for example, the presence & location of advertising boards (including any breaks for field of play access), and what can/can’t be within the normal angle of camera view. For the medical team, this may be an insistence that all the medical equipment is located next to the team bench or dugout. Or, it could be opposite – that none of the medical team or equipment can be positioned opposite the main cameras.

The general principles, however, is that there must be ‘someone’ present to respond to emergencies on the playing surface, and that their equipment should be ‘close at hand’. Those providing playing surface medical cover must be positioned where they have a clear, unobstructed view of the entire field of play.

Examples of playing surface medical cover

The above sets of rules will specify exactly ‘who’ should be present. This will be the minimum requirement for those matches.

As an example, English Premier League football matches require:

  • Three (3) doctors – registered medical practitioner licensed to practice by the General Medical Council, who hold current Football Association Advanced Trauma Medical Management in Football qualifications; two (2) of them must hold diplomas in sports medicine or equivalent or higher professional qualifications
  • Two (2) registered physiotherapist members of the Health and Care Professions Council, who hold current Football Association Advanced Trauma Medical Management in Football qualifications
  • Two (2) fully qualified and appropriately insured paramedics
  • One (1) fully equipped, dedicated and appropriately insured ambulance suitable to carry an emergency casualty and staffed by a Person or Persons qualified to perform essential emergency care en route
  • Whilst not specifically required, there is almost always a pitch recovery team of four (4) stretcher bearers, who are typically first aiders

In contrast, the Women’s British Basketball League (WBBL) requires that only the home club must provide a first aider for the game. The British American Football Association (BAFA) requires at least one (1) first responder & two (2) emergency first aiders (who may be coaches) for their games.

Initial response

In most cases, if a participant or official is injured, the response will be from the team’s own staff. Once called for by an official, they can make their way, calmly, with any equipment that appears to be immediately necessary, to the injured person. The notable exception is where a player suddenly collapses without any contact. In this case, authorised medical personnel (ie those listed on the team sheet as a medical doctor, registered physiotherapist or therapist; or those accredited for the game as the emergency medical responders) can immediately enter the playing surface without play needing to be stopped.

Generally speaking, this response will be ‘fast walking with urgency’. There won’t be any rushing or panicking. But there is a need to get to the patient quickly, yet safely. Again, the one exception to this is that the person carrying the automated external defibrillator (AED) may run/sprint if they can see cardiopulomonary resuscitation (CPR), ie chest compressions, have started.

After that inital response, once a quick assessment has been carried out, they will communicate what else is needed immediately. That could be oxygen, a splint, an orthopaedic (scoop) stretcher with head blocks, medicines, or something else. At this stage, the call is for ‘more people’ with the ‘stuff’ that will preserve life & prevent deterioration. A call for further assistance should also trigger the process for protecting privacy & dignity. Those assisgned to collecting whatever will be used for screening the incident area should bring them onto the playing surface.

Once that’s on its way, and life-saving interventions have been started, consideration will be towards the ‘end goal’. Often it’s getting the injured patient to a suitable place where they can be fully assessed & stabilised. If appropriate, with a view to transferring them to definitive care. A stretcher, or carry chair, or wheelchair, or even just crutches, might be called for.

Removing patients from the playing surface

It takes time to stabilise & package a patient for transfer. That’s as true for ambulance drives to hospital as it is for carrying someone into a medical room.

The most important consideration is that a patient is stable enough. Patients shouldn’t deteriorate during the time it will take to get from A to B. It also means that how they’re getting from A to B won’t worsen their illness/injury.

In most professional sports, the target is less than 10 minutes. From the point that play is paused to the patient being clear of the playing surface should be less than 10 minutes. The exception is resuscitation, because a return of spontaneous circulation (ROSC) is followed by at least 10 minutes of not moving to give the patient the best chance to stabilise themselves.

Moving the patient from the place of injury to the nearest sideline is the quickest part. Loading & securing the patient takes more time, but not much more. The time-consuming part of the overall process is stabilising the patient. Putting on splints, securing airways, immobilising spines all takes time. From ordering the stretcher, to when it needs to arrive, could be a few minutes, rather than a few seconds. Walking to the patient with the extrication equipment is always correct.

Bringing too much equipment to the patient has problems. When providing patient care, you need to be able to reach the equipment required at that point without moving. There’s only so many people who can be next to the patient. And there’s only so much space around each of them. To ‘package’ the patient onto the transfer device requires a clear space. Those providing the initial stabilisation will need to move clear. Then the team who will transfer the patient can move in with their equipment.

ProMed’s playing surface medical cover

As part of our event healthcare services, ProMed offers a playing surface medical cover solution.

Our planning starts long before match day. We start drawing up our plans before we have the fixture list!

Playing surface medical protocol

ProMed’s operations team works with sports clubs/teams & venues to write playing surface medical protocols that are specific for each sport/competition. We have a proven record of working with team medical leads, competition officials, sports presentation producers, broadcast producers, venue stewards, security contractors, statutory ambulance services, NHS hospitals & private hospitals to develop shared plans for emergency situations.

Ensuring that all departments understand what will happen is essential. The time to start working out who will do what is not when the first player is injured. How tasks will be carried out is an important part of the protocol.

We look at all aspects of providing care to injured players & officials:

  • Where is the equipment for the playing surface located?
  • How will it get onto the field of play, and who will bring it?
  • Where are the medical staff allocated to playing surface response seated?
  • Under what circumstances can medics enter the field of play?
  • How do the medics cause the game to be stopped if they need to urgently intervene?
  • What will be used to provide a privacy/dignity screen, and who will bring it?
  • How will everyone involved in the response communicate with each other & beyond?
  • How will the in-venue spectators/crowd be informed of the situation?
  • How will viewers of the live broadcast be informed of the situation?
  • Who will manage the press & media representatives present?
  • What methods of extrication will be available & under what circumstances are they expected to be used?
  • If the outside broadcast has replay capability, how does the medical team access this?
  • Where will an injured patient be taken when removed from the playing surface?
  • Where can an emergency ambulance park – both standing by & when collecting a patient?
  • What hospitals are nearby, what specialist facilities do they have, and how will they be contacted?
  • What other facilities are nearby, and what is their referral process for urgent cases?

All other documents – briefings, guides, plans, etc – refer back to this protocol. Consistency is vital in ensuring that the best care is provided.

ProMed’s field of play kit

Our provision includes all equipment & consumables required.

Immediately available at the playing surface, we typically provide:

  • An Automated External Defibrillator (AED) – often one per team
  • A first aid kit including observations pouch & catastrophic haemhorrage management
  • An oxygen cylinder bag with adjuncts to Basic Life Support (BLS)
  • A mixed analgesic gas cylinder bag
  • A long (spinal) board with straps & head blocks
  • An orthopaedic (scoop) stretcher with straps & head blocks
  • A folding stretcher
  • A carry chair with blanket
  • A set of Ten Second Triage (TST) cards & tally charts

We will provide a handportable radio with earpiece for each member of ProMed staff, and at least one per team (for their lead therapist or other designated person). We can also provide radios for an officials’ representative, competition organiser, spectator/crowd event healthcare provider, venue control room or other necessary personnel as required. Playing surface medical staff will operate on their own channel (distinct from spectator/crowd staff). We use Digital Mobile Radios (DMR), setup with individual IDs. If required, we can set them up so that each team is isolated from each other, but that our staff can hear everyone, and everyone can hear our staff.

Field of play medical room

ProMed can be responsible for furnishing a team/player medical room. Our facilities can take an empty, private space to a resusicitation / minor procedures room. The absolute minimum we require is that there is cover on all sides & the top, a wipeable floor, a doorway capable of permitting stretcher access with people either side, and that the space is large enough for our kit and our staff to work.

Our comprehensive kit may include:

  • A conventional ambulance (trolley/cot) stretcher with linen & blankets, compatible with any emergency ambulance we arrange
  • A primary response bag with oxygen cylinder & adjuncts to Immediate Life Support (ILS)
  • A multiparameter (cardiac) monitor with manual defibrillator
  • A powered suction unit
  • Large cylinder of oxygen with regulator
  • Large cylinder of mixed analgesic gas
  • Intubation roll with bougies & laryngoscopes
  • Drugs bag with all JRCALC drugs, suitable formulations for both adults & paediatrics, and additional drugs requested by the medical doctors for the game
  • Cannulation bag
  • Infusion bag
  • Mini-fridge for medicines which require cold storage
  • Drawer set with first aid consumables, sports bandages, tapes, suture kits, sterile fields, surgical gloves, etc
  • Clinical waste bin, sharps bin, landfill/recycling bins
  • Assorted immobilisation splints – box, vacuum, mouldable
  • Pelvic binders
  • Cervical spine immobilisation collars
  • A long (spinal) board with straps & head blocks
  • An orthopaedic (scoop) stretcher with straps & head blocks
  • A folding stretcher
  • A vacuum mattress
  • A carry chair with blanket
  • A wheelchair
  • Procedures trolley
  • Signage for current Resusciation Council UK algorithms
  • A set of Ten Second Triage (TST) cards & tally charts
  • A set of Major Incident Triage Tool (MITT) cards & tally charts
  • Desktop or laptop computer, with internet connectivity
  • Desk VoIP phone
  • Tablet device
  • Transportable (desk mobile) radio with fist mic, power supply & antenna
  • Overhead lights, floodlights, desk lamps
  • Water dispenser, urn
  • Heaters, fans
  • Tables, benches, chairs, shelving

Through our extensive supplier & partner network, we can arrange for chest freezers, crushed/cubed ice, cool boxes & ice bags for sports fixtures.

Poster for Emergency Action Protocol (PEAP)

The Set-piece approach for medical teams managing emergencies in sport (Patterson et al, 2022) has been adopted for professional football matches worldwide.

ProMed has created bespoke PEAPs for each sport we cover. These identify the key roles required with space to write on who is allocated for each game. The diagram of the patient has images of our equipment in its optimum position.

Every game or match starts with a “whole team briefing”. This goes beyond the ProMed staff, and includes representative from each team playing. We’ll also invite a competition representative, spectator/crowd event healthcare representative, venue representative & security representative. Our goal is to ensure that everyone involved in dealing with a playing surface medical incident has the same shared understanding of what will happen, how it will happen, and who will be responsible for each task.

The Poster for Emergency Action Protocol will be displayed in the team/player medical room. It will be populated with named individuals against each role. The team leader & their contact details are identified. And the pre-alert number for the nearest A&E is displayed.

Once everyone knows their roles, we provide them with action cards. These are colour-coded to match the PEAP board. They contain explicit instructions for the initial management of a patient, with the top half being ‘memory items’ and the lower half being continuing actions. As well as being a checklist, they are designed to record key information which can later be used as part of the patient’s clinical record.


All sports fixtures must have arrangements in place for dealing with injuries that occur on the playing surface. This should include the presence of suitably qualified individuals, and the provision of suitable kit. The Resuscitation Council (UK) has produced best practice guidelines for Resuscitation on the Field of Play.

The field of play medical team should be distinct from the event healthcare provision available to spectators. They can be supplied by the same provider, but their operation must be seperated.

The immediate response to an apparently injured player starts with their team therapist being invited onto the playing surface by a match official. If kit is needed to manage their injuries, this is communicated to the team, who will bring what is required, along with dedicated personnel to provide privacy screening. With this underway, an extrication method is selected, and the pitch recovery team will bring the appropriate device to the pitch to be used once the patient has been stabilised.

Players will often be taken to a suitably equipped medical room dedicated for the playing surface. They may need to be transferred by emergency ambulance, either to a hospital emergency department or other urgent care facility (including private imaging).

Book your playing surface medical cover

If you need to arrange playing surface medical cover for your fixtures, either as a one-off or as part of a regular competion, please contact us!

Email, call 03333 445442 or WhatsApp 07418 310101.

We operate throughout the UK, and have experience in Birmingham, Bolton, Glasgow, Kirkcaldy, Leeds, London, Manchester, Norwich, Southampton & Stoke-on-Trent.

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