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Remodelling crowd medical services in the English football league, a study by LSBU and Millwall Football Club

Remodelling crowd medical services in the English Football League, a new joint study by London South Bank University and Millwall Football Club
04 May 2018

A modern approach to providing medical services at football grounds can substantially improve the care given to crowds, says a new study entitled, ‘Crowd medical services in the English Football League: remodelling the team for the 21st century using a realist approach’, published in BMJ Open and authored by  Professor Alison Leary, Chair of Healthcare Workforce Modelling and a team of researchers at London South Bank University’s (LSBU) School of Health and Social Care.

This study has been supported Lewisham Council and other emergency services.

The research looks at emergency service provision during 981 episodes on the pitch at Millwall Football Club, over a 14-year period from 2002-2016 and concludes that the demographic and type of presentation in each case, did not change over the course of the 14-year evaluation period.

First-aiders were involved in 87.7 per cent of episodes of care, nurses in 44.4 per cent and doctors 17.8 per cent. There was an apparent downward trend in referrals (mean 6.25% to 4.5% per year) to hospital even though crowd sizes have increased, with many issues being dealt with directly at the ground taking the pressure off local emergency departments. During this period workforce feedback was positive.

The findings show that the proposed new healthcare workforce model, managed to meet increased service demands while reducing the number of referrals to acute care. The new approach allowed the first aid workforce to get involved in more complex care and key decision-making processes while optimizing the skills mix of the team.

Results in this study also show that emergency demand is much more likely to come on a regular basis, from patients with minor injuries, exacerbations of illness, pre-existing conditions and occasional emergencies than major incidents with mass casualties and that this should be fundamentally factored in when considering stadium safety.

By changing the way that they work to deploying a flexible and agile smaller team of trained medical staff, Millwall FC have introduced a model that can accommodate both immediate disaster management but also a high volume of minor injuries, medical emergencies and primary care work.

Formal crowd medical services were introduced as a result of the Hillsborough stadium disaster in 1989. Professor Leary, who has advised and worked with Millwall Football Club on its approach to deploying emergency medical healthcare teams for over 20 years, used this study to explore whether a mixture of first-aiders, nurse practitioners and doctors working in a team based approach could improve care, without increasing the level of risk to the health and welfare of fans and players.

Professor Alison Leary said: “The new model of employing a smaller dedicated team, as we have done at Millwall FC, makes sense when you consider that the shift in demand on services in present-day spectator care rarely derives from major mass casualty situations.  In recent years, austerity measures in England have also placed resource constraints on healthcare service providers such as the statutory ambulance service and the acute sector. Managing demand at source has become a fundamental necessity.”

Micky Simpson, a Lions supporter of 25 years standing, who is the club’s ‘fan on the Board’ representing the fans’ interests, said: “Millwall is often classed by some as the smallest club in the League financially but it undoubtedly has a Premier League level medical team.

“If a fan has a heart attack during a game, we have the advantage that with our professional medical team, we can diagnose whether they are actually having a heart attack or not, and decide quickly whether to send them straight to a Cardiac ward and not just straight to A & E.”

Read the full report.