“Does your colleague know what to do in the field in case of a medical emergency? And you?" When traumatic and non-traumatic emergencies occur in football, it is imperative that healthcare professionals responsible for players are trained and equipped to recognize and provide appropriate care.
To support and promote a consistent level of emergency medical care on the football field, reduce errors and limit human error, the Federation Internationale de Football Association (FIFA) proposes a standardized protocol for medical teams handling emergencies in sport: the poster for emergency action planning. (PEAP).
The FIFA PEAP (figure) illustrates a process by which medical teams organize to provide priority care in emergency scenarios and minimize the risks inherent when working in the complex and often publicly viewed pre-hospital environment of competitive football.
By linking key clinical interventions to predetermined functions, PEAP helps teams manage the challenging human factors inherent in a time-critical emergency on the playing field. Importantly, FIFA PEAP moves away from the more traditional reactive team dynamic to a more proactive team preparation model .
Proactive team behavior: the scenario
Regardless of where the emergency occurs, the clinical elements of recognizing and managing a medical emergency or trauma remain the same. Football terminology of a "set piece" has been borrowed to describe the optimal process, where a team practices for a planned scenario, with each member designated to play a role and the accumulation of these roles leading to the goal.
Fixed thinking enables optimal team performance by allowing each individual to remain focused on the task without distractions.
A team leader or ’captain’ of the medical team must be pre-designated and is ultimately responsible for coordinating the emergency response. This role may be assumed initially by the first responder (often the team doctor) who would perform the initial assessment in the field and begin management, before moving to a more non-interventional role to coordinate the response, or handing these responsibilities over to a Default team leader (when they arrive on scene).
Regardless of the clinical scenario, the emergency response process should not change. This sequenced and reproducible process requires team practice and scenario-based training by medical staff and designated first responders to minimize stress and improve efficiency when called to action.
Task assignment
One of the main challenges in providing healthcare for football is the inconsistency in the resources available within the facilities. The FIFA PEAP aims to add a consistent approach that can be adopted by most multidisciplinary teams (MDTs) and defines the minimum clinical resources and associated skills required for each role.
The PEAP is designed for all football players, both in competitions and training. It is a general process that is equally applicable to places with high-functioning emergency systems already in place and those with more moderate resources.
To achieve this, we have placed emphasis on the key interventions necessary to resuscitate and stabilize a patient and the skills necessary to perform these procedures. This approach allows the integration of clinicians with emergency skills (such as doctors, paramedics and nurses) and allied health professionals with other skills (such as physiotherapists, sports trainers, sports therapists and first aiders) into an MDT.
Practicing to perfection
Within the PEAP, roles are assigned and practiced prior to team deployment, so that when an emergency occurs, team members already know their role and responsibilities in the process. These are color-coded and represent the positions and responsibilities each member must take during a scenario, as described in Figure 1.
Each club can have staff to fulfill each of these roles and practice their emergency response together before the start of the season. In some circumstances, the visiting team may require home team personnel to fill all roles. This should be determined before match day and role assignment made at the pre-match medical meeting (suggested 1 hour before kick-off) or pre-training briefing. As part of PEAP adoption, teams should introduce time for this key communication or so-called “medical timeout” into their regular pre-activity routine.
Creating strong team communication
A synchronized and well-practiced set piece allows teams to work efficiently and without getting in each other’s way. However, the task-focused element of most team members’ roles places increasing importance on communication and supervision by the team leader.
Communication within the team is key as it allows team members to communicate through the team leader who provides situational awareness and coordinates the scenario. The team should practice closed-loop communication where the team member alerts the rest of the team through the team leader when each task is delivered.
It is inevitable that team communication and performance will be challenged by stressful and time-critical medical emergencies, which is why the PEAP is designed as a reference document for use during team activity. All roles and communication channels must refer to the FIFA PEAP as a tool to maintain clear team direction, organization and leadership in times of stress.
Conclusion A medical emergency in football is a challenging and stressful situation for any doctor. To provide the most efficient response, best prioritize care, and optimize medical team performance, we recommend moving from a reactive team dynamic to a proactive team readiness model . FIFA PEAP provides a structure by which any medical team supporting the field can deliver a reproducible system using a fixed-part process to ensure optimal player care when a medical emergency occurs. |
