In the final round of a boxing match, Mr S was knocked to his knees. He managed to stand up but then collapsed on the floor of the ring. The referee stopped the fight and called for medical assistance.
Dr Y and Dr D were employed as ringside doctors at the event.
They entered the ring immediately, cleared Mr S’s airway and put him into the recovery position. After a few minutes, Mr S was transferred to an ambulance that was kept on standby at the event. The ambulance had only basic equipment and was staffed by untrained ambulance drivers who were unable to intubate.
Mr S was taken to the nearest hospital with neurosurgical facilities.
In transit, Dr Y inserted an airway and administered oxygen via a facemask. Mr S arrived at A&E in N hospital 40 minutes after the incident. He had a GCS of 6/15 and an oxygen saturation of 75%.He was immediately intubated and resuscitated. A CT scan of his head showed a large subdural haematoma.
Mr S was then taken to theatre for craniotomy and evacuation of the haematoma. The procedure took place within 25 minutes of the initial intubation.
Mr S recovered but was left with right-sided hemiparesis, decreased cognitive power, memory deficit and chronic headache. He subsequently made a legal claim against both Dr Y and Dr D.
A GP expert, with experience of acting as a ringside senior medical officer, felt that management of a significant head injury caused by boxing should have followed advanced life support guidelines. Mr S should have been intubated and ventilated at the scene then intravenous access secured.
Dr Y and Dr D should have ascertained what equipment and staff resources were available to them prior to the fight’s commencement.
In view of the lack of paramedic support, or a fully equipped paramedic ambulance, the doctors should not have allowed the fight to take place.
A neurosurgical expert felt that the aim of resuscitation in such circumstances should have been to ensure that cerebral oxygenation was maintained and brain swelling controlled. If the equipment had been available to deliver adequate resuscitation immediately, the level of the patient’s subsequent impairment would have been less.
The case was settled in favour of the claimant for £315,000 plus costs of £170,000.
Provision of medical care at many sporting and other events is essential in order to ensure the safety of both participants and audience members. However, clinicians working at such events are stepping out of their usual environment and into the world of pre-hospital care. Before accepting such roles, clinicians should take on board the following points:
- Ensure all skills are up to date and that qualifications are appropriate for the event.
- Acquire basic knowledge of the sport, its risks and the possible injuries participants may sustain.
- Ensure that appropriate medical equipment and support is available, according to the ruling body’s requirements and professional opinion.
- Become acquainted with the guidance of the sporting organisation.
- Become familiar with the local emergency services.
- Discuss and arrange appropriate professional indemnity arrangements.
- Ensure that the level of responsibility is agreed with the event organiser (participants and/or crowd numbers).
Doctors’ Assistance to Sports Clubs and Sporting Events, British Medical Association, www.bma.org.uk
Short courses on sports events are held regularly by the British Association for Immediate Care, www.basics.org.uk