BAFA Rules Committee

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Changes to medical facilities

4th December 2005

We are proposing that it is not essential to have an ambulance at the game.

There are other sports that do not have a requirement for an ambulance. There are other parts of the world that do not require an ambulance at American football games.

Comparison with rugby

The nearest "common" British sport to American football is rugby. While the degree of contact between players is more intense in American football, players must wear considerably greater levels of padding and mandatory equipment than rugby players. Players are at risk of similar injuries to lower limbs, while neck and spinal injuries are a risk in both sports (though thankfully rare).

The following extracts from rugby union websites show that rugby does not require nor advise clubs to have an ambulance present at games.

Advice to rugby clubs (A-Z of community rugby)

Health and safety

First Aid

It is recommended that all Community Rugby clubs have at least standard 1st aid equipment (see below) and a trained person on match days and at training nights. Larger clubs competing above level 8 should also have easy access to a special medical facility. Zurich Premiership and National Division 1 grounds should be equipped with first-aid points in line with local authority guidelines.

Guidelines for Standard First Aid Equipment Box:
  • Guidance Card
  • Individually wrapped sterile adhesive dressings (assorted sizes) x 20
  • Sterile eye packs with attachment x 2
  • Individually wrapped triangular bandages x 6
  • Safety pins
  • Medium sized individually wrapped sterile wound dressings x 6
  • Large individually wrapped sterile wound dressings x 6
  • Extra large individually wrapped sterile wound dressings x 6

Boxes should be clearly labelled and accessible and emergency first aid should only be given by a qualified first aider. A list of all first aiders should be clearly communicated to the whole club i.e. in club handbook or on the notice board. Under no circumstances should analgesics be administered by first aiders or kept in the first aid box.



English Clubs Championship regulations

22.  Medical Safety

Wherever possible, the home team should ensure a doctor or other medically qualified person is in attendance throughout the match and in addition there must be access to a working telephone (whether a mobile or otherwise) adjacent to the pitch.

Comparison with football in the USA

The USA is the home of American football and it therefore appropriate to compare the medical requirements at games there with those in Great Britain. It should be noted that many participants (players, coaches, others) in the USA might be more experienced than their counterparts in GB. However, this is not always the case.

As the following extracts show, the requirement for an ambulance is mixed.

Chicago high school survey

Of the 47 (79.7%) schools that had a football team, 5 (10.6%) had physician coverage of home varsity football games; 4 were family physicians, and 1 was an orthopedic surgeon. Of the schools with teams, 4 (8.5%) reported that athletic trainers were present at home varsity games, while 42 (89.4%) had paramedics at these games. No schools arranged for an ambulance to be on site during games, but they had ambulances on call. Of the schools with football teams, 42 (89.4%) of 47 schools had coaches who were certified in CPR and basic first aid.

At football practice, no school had a physician or paramedic present. Only 1 of 47 (2.1%) schools that had football teams had an athletic trainer present at practice to deal with medical problems. In 46 of 47 (97.9%) schools, coaches were the only ones available at practice for medical problems.

Lincoln Nebraska incident

An article by Ken Hambleton, journalist with the Lincoln, Nebraska, Journal Star (September 2004)

Did Lincoln Public Schools sacrifice safety for budget? LPS saved $3,800 last year and more this year by cutting on-site ambulance service. LPS felt secure enough in the average response time of 4.8 minutes to turn down offers from private citizens to cover the cost.

Now, LPS is willing to accept donations (436-1612) and will have ambulances on site at varsity games the remainder of the season. LPS and Nebraska Wesleyan turned down offers of free or drastically discounted ambulance services outside of Lincoln because the contract with the Lincoln Fire Department does not allow it.

n About $14,000 of your tax dollars pay for 70 or so Lincoln police to work overtime to monitor Nebraska football games (not including traffic control). LPS funds (your tax dollars) pay for LPD officers to staff city public school athletic events. But funds were cut for paramedics at football games at relatively the same rate.

n No ambulance is on site for junior varsity, reserve and freshman football games or any other Lincoln high school sports. Nor have there been ambulances on site for football practices

n It makes some sense that varsity players are typically larger, stronger and faster than the JVs. The varsity players hit harder and deliver a greater blow, thus creating a greater risk of severe injury. For instance, you rarely hear of severe head injuries in midget football games, yet the equipment is relatively the same.

In some Nebraska cities, the rescue squads volunteer time to staff games. In some rural Nebraska cities, there is no rescue squad, no trainer or any other medical help immediately available. For that reason, the Nebraska School Activities Association has no policy about ambulances or medical personnel on site at games but ...

n The Huskers and the NSAA pay for ambulance, Red Cross, paramedics and certified trainers to be on site for the state football finals, state volleyball finals, state basketball finals and state wrestling championships but not at district competitions across the state.

n Football safety is light years ahead of standards of just 20 years ago. Helmets must meet a safety standard. More and better medical advice is available. Ask anybody over 40 years old who played high school football, and they'll tell you they were told not to drink water and told to take salt tablets and eat steak before a big game. Football-related deaths, once as high as 70 per years, dropped to three last year and two of those occurred from high school football game injuries.

n Beran is apparently the first Lincoln high school athlete in more than 30 years to suffer a life-threatening brain injury in high school competition.

n Catastrophic injuries related to football in Nebraska are few. Since the mid-1980s, there appears to have been three cases involving football injuries that required the catastrophic insurance carried by the NSAA.

n The Center for Disease Control said in 2001 that 1.5 million Americans sustain a traumatic brain injury each year. The leading cause is of brain injuries and subsequent death is motor vehicle accidents. No. 2 on the list is falls. No. 3 is work-related accidents, followed by recreational sports.

(People sitting in the stands are almost four times more at risk of a head injury driving to and from the game, and climbing the stadium, than those people playing the game.)

n About 10 percent of college football players and almost 20 percent of high school football players sustain brain injuries. Varsity football accounts for about 63 percent of the cases of traumatic brain injuries in high school athletics. Wrestling accounts for 10.5 percent of high school sports brain injuries, girls soccer for 6.2 percent, boys soccer 5.7 percent, girls basketball 5.2 percent, boys basketball 4.2 percent and softball 2.1 percent.

n Every parent and participant signs a consent form that indicates participation can result in injuries, some catastrophic and some resulting in death.

n As the late Vince Aldrich, longtime Lincoln Pius X football coach said once, if you eliminated the four hours spent attending a football game - playing, cheerleading, playing in the band, watching friends play - you'd probably have more kids involved in serious accidents on a Friday night.

Links and further resources

Other sports

Press Release - Touchline Emergency Care course - March 2003

ABC First Aid Limited have announced the release of a range of Touchline Emergency Care courses designed specifically for the needs of Healthcare Professionals working in sport and exercise. Tony Bennison, ABC Managing Director, said today "Sports clubs who utilise the services of a touchline 'physio' usually expect this person to deal with all injuries on the field of play, regardless of severity. This often means that a therapy and rehab practitioner finds themselves having to make clinical decisions in areas outside their professional scope or training. The legal implications of this could be very serious for all parties."

Most touchline responders address the skills deficit by attending traditional First Aid courses - this at least gives a certificate necessary for insurance purposes. A common complaint though is that these courses are not pitched at an appropriate level and do not cover the extended skills often expected of the Healthcare Professional. In launching these new courses, ABC has addressed this problem, says Tony Bennison: "We work with many elite clubs, clinics and governing bodies and the touchline physios always have the same questions regarding airway adjuncts, c-spine immobilisation, suturing, reduction and splinting, etc. We have based these courses around their needs." He goes on: "It is not our intention to turn 'physios' into 'paramedics' but the touchline practitioner who is routinely expected to make critical decisions regarding, for example, head and neck trauma should have the background knowledge, skills and awareness necessary to cope with this - we are all professionally accountable..."

Each course is taught by experts in the field of emergency pre-hospital care and sport injury. They are run over 2 evenings so as not to clash with weekend or daytime jobs and are available at a variety of locations in the south and midlands - with more venues to follow soon. They can also be operated on-site at the clients' club if required. All delegates receive comprehensive handouts and a certificate of attendance, invaluable for CPD and PREP.

If you would like details of the above or other courses, or if you would be interested in hosting a course, please contact Tony Bennison straight away.

UK ambulance response standards ...

  • Category A covers emergency calls that are classified as life threatening, and ambulance services are expected to reach 75 per cent. of category A calls within eight minutes.
  • Category B is for non-life-threatening emergency calls, 95 per cent. of which should receive a response within the national 14 minutes in urban areas or 19 minutes in rural areas.
  • Category C calls are regarded as non-life threatening and non-urgent, and are a large proportion of the work of the ambulance service.

London Ambulance Service application of above:


RED 1 - Actual death imminent (Unconscious not breathing)

RED 2 - Possible death imminent (Unconscious/not alert but breathing, or with other signs like mechanisim of injury)

RED 3 - Risk of imminent death (breathing and conscious but at high risk)

N.B. All calls to children aged 2 and under automatically get a "RED 3" regardless of diagnosis.


AMBER 1 - Definitely serious (not immediately life threatening ,but requires urgent on scene assessment, treatment and conveyance)

AMBER 2 - Possibly serious (not immediately life threatening and on specific gain from immediate treatment on scene or in an A&E)


GREEN 1 - Requiring assessment and or transport (not life threatening or serious, but needs assistance)

GREEN 2 - Suitable for telephone triage and or advice (probably no need for transport telephone consultation can be used to determine the health care needed)


Sources of further information include...



Other sports

A game is different from training/scrimmages ...


  • Higher intensity
  • Longer
  • Involves more players
  • Under supervision of officials
  • Medical facilities prescribed


  • Lower intensity
  • Shorter
  • Involves fewer players
  • No supervision by officials
  • No medical facilities prescribed
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