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© Alamy - A member of the Newcastle United medical team runs to assist a fan in the stands

Football stadiums and medical emergencies – what’s the score?

There have been several high-profile incidents of fans requiring emergency health care in stadiums this season. But what healthcare is available for supporters at the match? Joe Cosgrove, a Newcastle United fan and consultant in Anaesthesia and Intensive Care Medicine at the city’s Freeman Hospital, explains more…

Since stadium disasters such as Ibrox and Hillsborough 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).

Every few years they update their guidance, often referred to as the Green Guide. The recent version was published in 2018 and had major input from Events Medical Services in the north east. So what cover is provided on a typical matchday at St. James’ Park?

The incident at Newcastle v Spurs game in October 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 delivery defibrillation (electric shock to the heart) within minutes. 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.

Medical cover in stadiums

In addition to four senior doctors, all of whom work fulltime in NHS hospitals, there are eight paramedics from North East Ambulance Service (NEAS) on duty for spectator care and 30-plus 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 matchday, plus other equipment and drugs to deal with a variety of emergencies. There are also three NEAS Ambulances available for transport to hospital and additional 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 matters about available personnel and facilities. This in turn may have created some concern for players and match officials. At Newcastle United we have personnel in excess of the basic requirements, and so do many other professional football clubs. Although the recommendations are based on crowd numbers, additional thought is given to crowd demographics and the nature of the event.

Heart attacks

The north east of England isn’t the healthiest part of the country and we have to consider such public health matters when planning. Furthermore, while we often 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, especially in men.

Studies include increased cardiovascular death in Dutch males with Holland going out of international competitions and increased heart attack rates in Germany during the 2014 World Cup. During the 1990s, there were increased cardiovascular deaths in men from West Yorkshire, Teesside, Wearside and Tyneside when one of Leeds, Middlesbrough, Sunderland or Newcastle lost at home.

Professional sporting organisations 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 also be emphasised that we’re there to assist in managing injuries and illnesses and have no facility to deal with long-standing or stable, chronic health problems that are best managed by GPs, pharmacists and community nurses.

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. We do therefore tend to see more injuries, rather than illness in this group of spectators.

However, amidst the 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 mini-bus. 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.

Are fans unhealthier?

We’ve always cared for some severely ill people at football but what seems to be becoming apparent this season, across 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 commented on this too.

There is also some recent evidence in the scientific journal Nature that some patients who have had COVID-19 infections that didn’t require admission to hospital have gone on to develop complications relating to breathlessness, damage to heart muscle, irregular heart-beats and the risk of angina/heart-attack.

It would be an unwise person to link everything to one thing but it’s clear that there are likely to be a number of factors mixing with each other that could increase the risk of acute illness in the stressful arena of a sports stadium.

I appreciate that this might be a bit left-field for the usual article but given the popularity of football and the health status of a lot of supporters, it’s worth more than just a fleeting thought.

Joe is a consultant in Anaesthesia and Intensive Care Medicine at Newcastle’s Freeman Hospital. In 2016 he 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 who died outside the Strawberry Pub in December 2016, after a 3-3 draw between Newcastle United and Manchester United.

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