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To stop or not to stop? That is the question – When a spectator collapses

6 months ago
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I recently wrote an article for The Mag that provided an overview of medical facilities and teams that are present inside St James Park on a match day.

Now, as many of you now know, some of that medical support was in action in the Gallowgate End during the second-half of the Aston Villa game.

As per the Spurs match it is inappropriate for me to comment any further on the individual incident, however, it’s probably worth looking at some of the events that occurred in relation to it. Namely, the referee suspending play.

This season, multiple medical incidents in football crowds have been highlighted in the media (MSM and Social.) A lot of the time play has been suspended despite there being no immediate impact on the field of play. It’s with this in mind that I would like to highlight the debate as to whether or not play should be stopped for crowd based medical emergencies.

To some this may feel, instinctively contentious and players/ match officials may feel under obligation to “do something,” but there are often very good reasons for not suspending play, especially in a large crowd.

In highlighting these issues, I should qualify my written words by stating that I work as a Crowd Doctor. I’m not an expert on Crowd Psychology, Crowd Movements or Security, but have worked with such experts for twenty years in Football, International Cricket and London-2012, and they’ve provided me with their insight and experience in the dilemmas that they faced and continue to face.

If we are to appreciate a bigger picture for spectator safety during a single medical emergency as opposed to a mass casualty incident, we need to understand (despite initial instincts to the contrary) that in the majority of circumstances suspending play has the potential to cause additional problems for spectators, safety / security staff and also players / match officials. In ethical and legal terms this could be described as coming under the banner of Distributive Justice i.e. the greatest good, for the greatest number of people. Considerations are outlined below:

1. Suspending play for an individual spectator can create safety issues for other spectators. Safety Officers and senior stewards (sometimes with the assistance of police) plan for certain crowd movements at certain points in a match. Sudden and unplanned suspension of play may have negative implications:

a. Stairwells, vomitories and concourses have the potential to become busier than expected

b. Catering outlets and bars may be unprepared for unexpected demand or even closed

c. Additional consideration will be required for wheelchair users and their movements at such times

d. Access to a second/simultaneous emergency (as was the case at St James Park in October 2021) may be hindered by unusual crowd flows

e. Evening kick-offs: a prolonged suspension may have significant implications for crowds leaving the stadium and looking for public transport, taxis etc.

2. Medical and security teams are appreciative that witnessing some treatments may cause distress for some, however, within society there is increasing awareness about treatments such as CPR. This may therefore be less of an issue than expected and possibly presents an opportunity for clubs to support not only spectators but organisations and individuals that provide community training in First Aid and Basic Life Support.

Additionally, there are also issues relating to the health of players and match officials. I appreciate that both groups have this season been the instigators in suspending matches, but a sudden cessation of play and prolonged stoppage puts them all at increased risk of musculo-skeletal injury, especially when the game restarts.

Finally, I understand that both the Football Supporters Association and the Sports Ground Safety Authority are working towards increasing awareness (for all) as to what the initial approach to a crowd based medical incident should be. They will be advising the FA, EPL, EFL, PFA and PGMOL (Professional Game Match Officials Limited).

In the meantime, spectators should not feel under any pressure to bring an incident to match officials’ attention; instead they should alert the nearest stewards who can in turn alert medical teams situated within the crowd. As this is occurring the stadium Safety Officer and colleagues will be in a position to view the situation on CCTV as it evolves and they’ll be best placed to advise the Fourth Official as to whether or not play should continue.

***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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