Mps receives a number of calls each year from junior doctors who are keen to get involved in assisting at sporting events, whether it is a GAA game, a horse trial or a motor rally. Sometimes, these requests are from doctors who do not have appropriate skills. Additional qualifications, such as an ATls certificate, are necessary to equip you with the effective triage and emergency medicine skills you will require when assisting with medical emergencies outside the hospital setting. without the necessary experience and qualifications you should consider very carefully whether you will assist at an event in a medical capacity.
Dr sonya mccullough, mps medicolegal Adviser, says: “If you are interested in assisting at sporting events, you should contact mps’s membership services in the first instance and put to them in writing your proposed additional duties. This way, mps can clarify whether or not you would be adequately covered to perform the role. This ensures that your profile is kept up-to-date to make sure that you are adequately indemnified for the duties you are carrying out.” most medical volunteers are involved in providing medical care for the crowds, officials and the administrators, alongside voluntary organisations and paramedics when required.
MPS advice for assisting at sporting events:
- Ensure all skills are up-to-date and that qualifications are appropriate for the event.
- Acquire basic knowledge of the sport, risks and possible injuries participants may sustain.
- Ensure that appropriate medical equipment to the sport is available according to the ruling body’s requirements and professional opinion.
- Become acquainted with the guidance of the sporting organisation.
- Be familiar with the local emergency services.
- Discuss and arrange appropriate professional indemnity.
- Ensure the level of responsibility is agreed with the event organisers. Should you be required to provide treatment to a member of the team, you should document your findings clearly and retain this record.
The importance of being indemnified
Appropriate indemnity is a key component when assisting at any sporting event. The medical council’s A Guide to Professional Conduct and Ethics for Registered Medical Practitioners (2009) states that: “You must ensure that you have adequate professional indemnity cover for all healthcare services you provide.” (50.1) make sure you are competent You should only volunteer if you are able to do what you say you can do and work within the limits of your competence.
The medical council agrees: “You should provide care in emergencies unless you are satisfied that alternative arrangements have been made. You should also consider what assistance you can safely give in the event of a major incident, a road traffic accident, fire, drowning or other similar occurrences.” (11.1)
Good Samaritan acts
There is a difference between officially assisting at an event, and helping out in an emergency, as part of a good samaritan act. mps defines a good samaritan act as one in which medical assistance is given, free of charge, in a bona fide medical emergency upon which you may chance, in a personal as opposed to a professional capacity, eg, assisting a fellow spectator at an event. For doctors, ignoring such a predicament is never an option. when called into action while off duty, you must remember to make a full clinical record after treatment. In such a scenario, you must assess your own competence in handling the situation – eg, you may be under the influence of alcohol – and proceed accordingly. only intervene if the situation is an emergency.
Any situation that is beyond your competence may still benefit from your input, to a degree. For example, you can use your clinical skills to take a history, make an examination to reach a preliminary assessment, and give an indication of the likely differential diagnosis. You can also suggest options for the management of the situation pending arrival of support. In the unlikely event that legal proceedings follow, members would be entitled to apply for assistance, no matter which country the legal proceedings are commenced in. when assisting at sporting events, the medicolegal risks remain the same as any other clinical encounter. Be sure to work within the limits of your competence, ensure good communication with and make sure you document any treatment given or decisions made. Domhnall macAuley, primary care editor of the BMJ, sums up the role of the medical volunteer: “like many of the backroom staff, their success is measured in how little you see of them.”1 You should be prepared and well-equipped to help immediately in those rare instances that you are needed.
Dr Lisa Cunningham is an orthopaedic sho at university hospital Galway, with BsTem (Basic specialty Training of emergency medicine).
The intern experience “mayo v Fermanagh National League match 2007. I’ll never forget it. It was my first prehospital cardiac arrest save. And Mayo won. I am part of the Order of Malta Ambulance Corps (OMAC), a pre-hospital voluntary organisation that covers duties such as football matches, festivals and concerts. On that day in question, I was a fourth year medical student, but cardiac responder trained with OMAC, and therefore had indemnity cover with them. The call came through on the radio, just as Ronan McGarrity caught a lovely highball midfield: a man in his 50s had collapsed in the stands and help was needed. The patient had suffered a cardiac arrest and the chain of survival was put into action. He was defibrillated and there was return of spontaneous circulation, followed by the patient vomiting on my friend’s uniform – the best feeling I’ve ever had. The patient is now living an active and healthy life as a result. That life-saving scenario made a huge impact on us all. It gave us confidence in our training. It made me even more determined to pursue a career in Emergency Medicine.
When I qualified, I remained an active member of OMAC, although they could not insure me as a doctor for my pre-hospital duties. With OMAC, you are going out of your way to find emergency situations. Being a doctor in such an emergency situation can often lead to increased expectations from the public in terms of your scope of practice and their expected outcomes. As an intern, you might have only been qualified for a few months, but sometimes the image the public see is one of you performing open-heart surgery at the side of the road.
So, what was next? I embarked on the Basic Specialty Training of Emergency Medicine (BSTEM). Indemnity is highlighted in the Irish Medical Council’s section on trainee divisions. It outlines that we are only allowed to practise in our clinical setting stated on our registration certificate. I have had numerous discussions with my superiors in relation to pre-hospital indemnity. The question I always ask myself is – at such an early stage in my career, is it worth the worry of advertising myself as a doctor and actually inviting pre-hospital emergencies which I may not be able to deal with and for which I have no indemnity?
For now, I will be content with actively enjoying the social outings and training with my group of friends in OMAC, but not on an official duty basis!”
For an account of cases that have been brought to court in relation to good Samaritan acts and the special circumstances for duty to intervene see: Report of the Civil law and reform of Good Samaritans and Volunteers www.lawreform.ie