Dr Ralph Mitchell
MDU member Dr Ralph Mitchell holds a coveted position at Wasps RFC. Here he explains a typical day in his role and his path to becoming a sports doctor.
I have always had a huge passion for sport and in particular rugby, ever since I was a young boy. I played the game at school and university and went on to be a national-level referee for several years with the RFU.
I then took up a role as a match day doctor with a semi-professional team in my local area, and eventually was invited to join a full professional team as their doctor - predominantly for the academy sides, but I also gained a lot of first team experience when the senior doctor was unavailable to do some of the match day duties. This gave me invaluable experience in making tough decisions and dealing with complex trauma injuries.
I was invited to join Wasps RFC in the summer of 2016, after they relocated to Coventry. My role with Wasps is mostly with the Academy and the A-league side, which contain up-and-coming talent as well as players who are coming back from injury, and I now combine this with my medical career as a GP.
A day in the life
A regular game day, if we are playing away, usually means a meet at the club several hours before the game to do an equipment check and finalise team lists. I usually bring up any players coming back from injury or those who have any medical illnesses and discuss their overall health and plans for injuries and illness with the strength and conditioning staff, physio staff and coaches.
At the ground we meet the away team doctor for a medical briefing and induction, as well as the local paramedic service, who help us with emergencies pitch-side. We set up all our own trauma kit, from suture kits to spinal boards, and do final checks with our oxygen cylinders and equipment.
During the game I work pitch-side with two physiotherapists, treating and assessing injured players. If the game is covered by TV, we also use video technology via an iPad, with a link to the broadcasters' feed, to help us identify any players who may have suffered a concussion and determine if they need to be removed. We also have the capability to remove a player temporarily for a head injury assessment (HIA), to give us more time to assess for concussion where there is diagnostic uncertainty on the field.
Concussion is our most common injury, but we are expected to deal with anything from a cardiac arrest to a broken leg or just a cut eyebrow. After the game we usually help treat and assess any injured player or player who needs hospital care, and then travel back with the team to the training base. On some away days, this can mean up to a 12 or 14 hour day for a game.
The right skills
GP skills come in very handy for sports medicine. I was fortunate enough to be asked to go to Russia last summer with the RFU England Counties U20 side as their team doctor. I was working with 25 players and eight management staff, and was responsible for all of their medical care. There was a lot of GP work, such as dealing with diabetic patients, managing an outbreak of viral gastroenteritis among the squad in the hotel, skin rashes, depression, and ENT conditions - all bread-and-butter conditions that a GP sees regularly.
Extra qualifications are also essential to work in sports medicine. I do an annual course on the management of polytrauma in the pre-hospital setting. Scenarios can include managing a player with a broken neck who is lying face down in the mud, or a cardiac arrest or an acute airway problem. The course is run by the RFU and is an essential requirement for any doctor or physio to work pitch-side in rugby.
As part of that course I also undertake a written exam and a trauma moulage scenario which is assessed and graded - a pass is essential to remain competent and be signed off to work in professional rugby. Apart from that, I have also completed suturing and minor surgical courses to maintain my suturing and tissue handling competencies, as well as joint injection courses. I am also studying towards a masters in sports medicine and work as a specialty doctor in sports medicine at the University of Leicester Hospital. All these skills and experiences help me remain competent to work in professional rugby.
There are lots of medico-legal areas within sports medicine at present. Currently, and in my own brief experience, some well-wishing people I have come across are volunteering at their children's rugby or soccer matches as a medic and do not have the necessary pre-hospital trauma care courses under their belt.
The MDU could only indemnify me once I had proven these skills with qualifications to allow me to do it. It is a potential medico-legal minefield for doctors to assume indemnity without any training or speaking to their defence organisation.
Before providing medical assistance at sporting events, even on a voluntary basis, you should make sure you have appropriate qualifications, skills, experience, equipment and support. The types of medical problems an event doctor faces can range from relatively minor cuts and bruises to acute traumatic injury of a participant, concussion, spinal injury, facial injuries or cardiac arrest. At smaller events, you may also be asked to treat crowd members who are taken ill.
In line with GMC guidance, you'll need to ensure that your skills and experience are appropriate for the task ahead. You will need to check you comply with relevant guidelines on equipment and support where available, and it may help to familiarise yourself with local health services, in particular the ambulance service, in the event that a seriously injured patient needs to be transferred to hospital.
If there is a medical problem during the event, your ethical responsibilities, such as the need to obtain consent and to maintain confidentiality, remain the same as in any other aspect of your medical practice. Consent can be written, verbal or implied and you have a duty to keep all information about patients confidential unless you have their consent to disclose that information. You should also keep detailed notes of any incidents and the medical care you provide.
You are required to have indemnity for any claims arising from attendance at a sporting event, in line with paragraph 63 of 'Good medical practice' (2013).
Some professional sports organisations or organising bodies provide indemnity for doctors acting in a professional capacity, and you would need to check this before the event. If the organisation can't provide you with indemnity, please contact us to check whether your current membership will indemnify you for this. This is equally important whether you are paid or planning to attend voluntarily.
We can indemnify you if you are caring for professional athletes or teams, but please discuss this with our membership team in advance to make sure you are appropriately indemnified.
Dr Ralph Mitchell
Ralph is a GP partner in Hinckley, Leicestershire and is also a specialty doctor in sports and exercise medicine in Leicester. He is one of the team doctors for Wasps rugby team and the England U20s counties team. He has also worked as part of the medical team for the 2014 Glasgow Commonwealth Games.
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