Football – A matter of life and death
The title of this article is paraphrased and taken from a quote often attributed to the late Bill Shankly, suffixed with “It’s more important than that.”
As far as I can search, there’s no firm evidence that he actually said such words, but there is a relevance to such sentiments, and a level of seriousness that may be well worth heeding for the sake of our own health.
I grew up in a “mixed” North-East Family but my Uncle Jack from Wallsend ensured I supported Newcastle United despite Joe (We used to go to St. James’ one week and Roker the next) Senior’s Hebburn approach to football.
As a lad growing up in 1970s / early 80s Co. Durham, I had the option of going to University in either Sheffield or Newcastle. I chose the latter because we signed Keegan in 1982. No ambitions to join the Bullingdon Club or equivalent, just a desire to regularly stand (and get partially crushed) in the Gallowgate Corner and hope / cheer for promotion.
And it’s from there that I’ve arrived at writing this article, as these days it seems like my life has come full circle. Having stood the Corner during the early 80s I, on occasion, find myself sitting there, although now in a professional capacity as one of four Crowd Doctors on duty at every home game, providing support to acutely ill or injured spectators, and it’s with such issues in mind that I’m writing this article.
Since stadium disasters such as Ibrox and Hillsborough (the latter precipitating the Taylor Report) there have been recommendations in place relating to the provision of medical cover at sporting events, and this has evolved under the guidance of the Sports Ground Safety Authority (SGSA) and the Department for Digital, Media, Culture and Sport (DCMS.) Every few years they update this guidance, which now includes an extensive chapter relating to the provision of medical services. The entire document is often referred to as the Green Guide. The most recent version was published in 2018 and had some major input from event services in the North-East.
Given the well-publicised medical incidents at football this season, it’s probably worth explaining what is provided on a matchday at St. James’ Park. Everyone is aware of the incident at the Newcastle United v Spurs game in October and whilst it would be unfair and lacking confidentiality to name people, the episode provided a good example of how sudden collapse can be dealt with by trained bystanders and the immediacy of NHS Paramedics, who were able to deliver defibrillation (electric shock to the heart) within minutes. The stopping of the game is for another discussion in a different environment. In the stands, having spectators who were able to provide basic life support and on-site professionals trained in using specialised equipment and drugs, enabled good care and treatment in a logistically, difficult environment, regardless of what social media had to say in the aftermath.
So what medical cover is available?
Well, in addition to the four senior doctors, all of whom work in either Emergency Medicine (A&E in old-money), Anaesthesia and Intensive Care Medicine or Cardiology, with being senior doctors in North-East Hospitals; there are also eight Paramedics from North East Ambulance Service (NEAS) on duty for spectator care and in excess of 30 First Responders for St. John Ambulance (SJA), a number of whom are senior nurses in North-East Hospitals. There are 16 defibrillators immediately available on a match day, plus other equipment and drugs to deal with a variety of emergencies. There are also three NEAS Ambulances available for transport to hospital. These are additional to NEAS vehicles already on the road. So, all in all there is a large group of professionals (within the crowd) capable of dealing with acutely ill or injured spectators at every home game.
We don’t publicise our role because we’re not there to worry people but recent events around the country, have led some to question about personnel and facilities available, which may in turn have created some concern for players and match officials.
As far as Newcastle United is concerned, we have personnel in excess of the basic requirement from DCMS, and so do many other professional football clubs, for although the recommendations are based on numbers, additional thought has to be given to crowd demographics and the nature of the event. The North-East of England isn’t the healthiest part of the country and we have to consider such public health matters when planning for events.
Furthermore (whilst we may joke about the stress of football), there is evidence from multiple countries that tense, high-stakes games can increase the risk of heart attack and stroke in men. Examples include Holland losing penalty shoot-outs in international competitions, Germany going out of their own World Cup in 2006 and during the 1990s, increased cardiovascular death in men from West Yorkshire, Teesside, Wearside and Tyneside when one of Leeds, Middlesbrough, Sunderland or ourselves lost at home.
There is therefore a very strong argument that professional sporting organisations and their associated clubs have a duty of care to anyone who falls acutely unwell or is injured at an event, hence the nature of the matchday medical team. It should be emphasised that we’re there to assist in managing injuries and illnesses and have no facility to deal with matters that are best left to GPs, Pharmacists and Community Nurses.
To finish on the subject of Crowd Doctors, a word for away fans. Anyone reading this who regularly goes to away games, knows that away support is usually more boisterous and proportionately consumes more alcohol, and we do tend to see more injuries, rather than illness, in this group of spectators. However, amidst the boisterous crowd are some very vulnerable individuals (adults as well as children) who often have significant physical and mental health problems. Many are quite gentle people who simply have a love for their team and they’ll often travel to every away game on a coach or in a minibus. Everyone will know them but no one really knows anything about them. If they fall seriously ill (as happens) there is often no one who can help provide health care professionals with any information about home address, next of kin etc. A little known but important group of people, that (more than the rest of us) warrant a duty of care.
Finally, a caution around public health issues. We’ve always cared for some severely ill people at football but what seems to be becoming apparent this season across multiple matches at multiple different clubs, is that ill spectators’ general health seems worse, and it may be that they’ve physically and physiologically deconditioned through various Lockdowns. My colleagues who assess people’s fitness for major operations have also commented on this trend. I appreciate that this might be a bit left-field for the usual article on The Mag but given the popularity of football and the health status of a lot of us in the North-East, it’s worth more than just a fleeting thought.
Joe Cosgrove, Consultant in Anaesthesia and Intensive Care Medicine and Lifelong Toon Fan.
Conflict of Interests: In 2016 I received a £5,000 grant from the Hillsborough Family Support Group to form the National Events Medicine Advisory Group and promote best practice in medical care for spectators at sporting events.
***This article is dedicated to the late Cliffy Ahmed of South Shields, who died outside the Strawberry Pub on 12/01/2016 after a 3-3 draw between Newcastle United and Man. Utd.
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