Questions and answers on medical facilities and risk assessment

BAFA, February 2017 (rules@britishamericanfootball.org)

What is this about?

This information sheet has been drawn up by BAFA to help teams, leagues and other organisations to formulate good practice in the provision of medical facilities and in the assessment of the risks surrounding football activities. This is NOT medical or legal advice. In case of doubt, please seek medical advice or legal opinion as appropriate.

What is risk assessment?

No activity is totally without risk, and the nature of football means that participants can suffer injury.

Many aspects of the rules are safety related, including restrictions on how players can legally contact each other and on what equipment is required and prohibited. The rules are reviewed each year, and the safety of the participants is the number one consideration in the principles that govern making changes.

Beyond the rules, teams, leagues and organisations can perform risk assessments to seek to identify and control the other things that may influence the safety of participants and spectators.

How do I do a risk assessment and what should it cover?

The Rugby Football Union have produced a document that provides guidance to their clubs. It can be found here. Note that our minimum requirements for contact football are approximately equivalent to theirs for senior mens rugby.

A risk assessment should cover any activity that poses a risk. For example, in football a risk assessment should cover both games and practices.

What else might I need to cover?

Teams may also need to be aware that they should be checking the Health and Safety Policy/Risk Assessment for the facilities they are using. Where a game is being played before a large crowd, sports ground safety regulations also apply. This matter is handled by the relevant local authority.

What are the minimum medical facilities required at a game?

The minimum medical facilities for contact football (11-on-11, 8-on-8 or 5-on-5) are listed in Rule 13-1-1.

ARTICLE 1. The minimum medical facilities during a game are:

A professional practitioner who meets the requirements below must be available.
1. The general characteristics are that the person must:
  1. Be a graduate in an appropriate discipline.
  2. Be a registered member of an appropriate professional body.
  3. Possess professional indemnity insurance.
  4. Hold a NQF Level 3 or higher first aid qualification.
2. Persons in the following categories who also have appropriate experience and training in immediate care (as represented by a NQF Level 3 first aid qualification) are likely to meet the requirement:
  1. Doctor registered with the GMC.
  2. Nurse registered with the NMC.
  3. Physiotherapist registered with the HCPC.
  4. Paramedic registered with the HCPC.
  5. Sports rehabilitator registered with BASRaT.
  6. Sports therapist registered with the Society of Sports Therapists.
  7. Sports massage therapist registered with the Sports Massage Association.
  8. Osteopath registered with the GOC.
  9. Chiropractor registered with the GCC.
3. This person must not be a squad member.
4. This person must have carried out a risk assessment and determined that they are competent and equipped to carry out emergency life saving.
A suitable first aid kit, approved by the professional practitioner above (or the lead practitioner, if there is more than one), must be available.
A telephone capable of use to summon the emergency services must be available (A.R. 13-1-1:II).

NOTE: Available means inside or immediately outside the stadium and fit for use.

STOP, REPORT & SANCTION -

Under no circumstances may the game commence, nor proceed if suspended. BAFA may apply sanctions for the following breaches:

Minimum medical requirement not met.

The stress is that these are the minimum facilities. It is entirely appropriate for teams to decide to provide facilities of a higher quality or quantity. For example, the medical requirement is met if there is only one medical person present, but a team might choose to have at least two.

The rulebook also contains a number of "approved rulings" that illustrate the application of the above rules.

There is no minimum medical requirement for flag football.

Who is responsible for deciding whether the medical requirement is met?

By Rule 13-1-2, game management is responsible for the provision of medical facilities that meet the requirements above, and the senior game management representative shall certify to the referee prior to the game that the medical requirement has been met. Game management shall inform the referee if at any stage during the game the medical requirement ceases to be met. The game will then be suspended.

Obviously, if the referee believes that the medical requirement is not met (e.g. it is not apparent who the medical personnel are), he should query it with game management.

Why is there no requirement for a mandatory ambulance?

There are a number of reasons:

1. It is widely accepted that the most important factor is that suitably qualified medical personnel be present. The speed issue is normally about providing immediate first aid, not usually about transporting someone to hospital. This has been confirmed by medical professionals who were consulted by the Rules Committee. There may be situations where the immediate availability of a means of conveying a patient to hospital may make a difference to their ultimate outcome, but these are said to be extremely rare.

2. Since mobile phones are now almost universal, it is easy to summon an ambulance quickly when needed. Ambulance services also have response time standards that reduce the likelihood of a long wait for an ambulance to arrive.

3. The "conventional" British sport most like American football is rugby. While the differences between the sports are significant, the sorts of injury that might occur in each are comparable. The Rugby Football Union's advice to clubs is to have appropriate medically trained personnel, first aid kit and telephone available at the game, and to have vehicular access for an ambulance or other emergency vehicle. There is no requirement for an ambulance to be present.

4. In the USA, there is no general requirement for an ambulance to be present at football games.

How do I know whether my medical personnel are qualified?

In most cases, you can look them up online.

To practice in the UK, a doctor must be registered with the General Medical Council (http://www.gmc-uk.org/).

Similarly, nurses must be registered with the Nursing and Midwifery Council (http://www.nmc-uk.org/).

Paramedics and physiotherapists must be registered with the Health Professions Council (http://www.hpc-uk.org/).

Sports rehabiliators must be registered with BASRaT (http://www.basrat.org/).

Osteopaths must be registered with the General Osteopathic Council (http://www.osteopathy.org.uk).

Chiropractors must be registered with the General Chiropractic Council (http://www.gcc-uk.org/)

All the above bodies allow you to check on their website to see whether an individual is registered or not.

Sports therapists must be registered with the Society of Sports Therapists. Sports massage therapists must be registered with the Sports Massage Association. Neither of those organisations currently has an online registration check facility so you should use other means to check their registration.

Persons with similar job titles who are registered with organisations other than those listed above are NOT qualified to meet the professional practitioner requirement for American football. Persons registered with organisations listed above but in other job roles are also NOT qualified to meet our requirements.

If your medical personnel are provided by an organisation (e.g. a private ambulance service or an agency), you should ensure that the provision of suitably qualified personnel is part of your formal agreement with them.

If I want a medical professional with a particular specialisation, what should I look for?

While the minimum requirement in the rules is met by any registered doctor, one trained and experienced in one or more of the following areas may have additional skills relevant to the task:

trauma / orthopaedics
accident & emergency
anaesthesiology

Similarly a nurse may have undergone specialist training in one of the above areas.

BAFA Rules Committee