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An analysis of consultations with the crowd doctors at Glasgow Celtic football club, season 1999–2000
  1. M Crawford1,
  2. J Donnelly2,
  3. J Gordon3,
  4. R MacCallum4,
  5. I MacDonald5,
  6. M McNeill6,
  7. N Mulhearn7,
  8. S Tilston8,
  9. G West9
  1. 1Hairmyres Hospital, East Kilbride, Scotland, UK
  2. 2The Royal Infirmary, Lauriston Place, Edinburgh EH3 9YO, Scotland, UK
  3. 3Accident and Emergency Department, The Royal Alexandra Hospital, Paisley PA2 9PN, Scotland, UK
  4. 4Accident and Emergency Department, Victoria Infirmary, Glasgow G42 9TY, Scotland, UK
  5. 5162 Nithsdale Road, Glasgow G41 5RU, Scotland, UK
  6. 6Glasgow Royal Infirmary, Glasgow G4 0ST, Scotland, UK
  7. 7General Medicine, Falkirk and District Royal Infirmary, Majors Loan, Falkirk FK1 5QE, Scotland, UK
  8. 8Department of Dermatology, Monklands Hospital, Monkscourt Avenue, Airdrie ML6 0JS, Scotland, UK
  9. 9Woodside Health Centre, Barr St, Glasgow G20 4RL, UK
  1. Correspondence to: Dr MacDonald, 5 Merrylee Road, Glasgow G43 2SH, Scotland, UKian_macdonald31{at}hotmail.com

Abstract

Objective—To analyse all clinical presentations to the crowd doctors at Scotland's largest football stadium over the course of one complete season.

Methods—A standard clinical record form was used to document all consultations with the crowd doctors including treatment and subsequent referrals. The relevance of alcohol consumption was assessed.

Results—A total of 127 casualties were seen at 26 matches, a mean of 4.88 per match. Twenty casualties were transferred to hospital, including one successfully defibrillated after a cardiac arrest. Alcohol excess was a major contributing factor in 26 cases.

Conclusions—The workload of the crowd doctors was very variable and diverse. The social problem of excessive alcohol consumption contributed considerably to the workload. The provision of medical facilities at football grounds means that attendance there is now one of the least adverse circumstances in which to have a cardiac arrest. The study confirmed previous impressions that more casualties are seen at high profile matches.

  • crowd doctor
  • major sporting event
  • football grounds
  • Gibson report

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Take home message

Crowd medical care at football grounds requires cooperation among first aid workers, ambulance staff, and doctors. Doctors doing this work should have appropriate training and expertise.

There have been three major disasters in one generation at British football grounds: at Ibrox Park in 1971 causing 66 deaths, at Bradford in 1985 causing 40 deaths, and most recently at the Hillsborough Stadium in Sheffield in 1989 causing 95 deaths. In the aftermath of these tragedies, there have been substantial changes in the requirements for the provision of safety at football grounds. These followed recommendations in the Wheatley report1 published after the Ibrox disaster, and then more comprehensively in the Taylor report2 into the Hillsborough Stadium disaster. In conjunction with the Taylor report, the Gibson report3 made specific recommendations for the provision of medical care at football grounds. These recommendations have been described in previous articles on this subject by other authors.4, 5

A central recommendation of the Gibson report was the responsibility for clubs to provide suitably trained and equipped crowd doctors. Attention has recently been drawn to the incomplete implementation of this recommendation in Scotland.4 The authors are the crowd doctors for Glasgow Celtic, one of Scotland's leading football clubs. Since the development of its new enlarged stadium, Celtic now require three crowd doctors for each game. These doctors are drawn from the disciplines of accident and emergency medicine, anaesthetics, and general practice, ensuring the provision of a good mixture of skills. There is a consultant anaesthetist at every game, ensuring that the highest level of resuscitation skills is always available. The general practitioners involved have obtained Advanced Life Support Provider certification from the UK Resuscitation Council. The accident and emergency consultant and one general practitioner have the Major Incident Medical Management and Support (MIMMS) certificate. At virtually every game there is a MIMMS trained doctor on duty.

The crowd doctors are in radio contact with the Scottish Ambulance Service control point and work from the trackside or upper tier of the stadium alongside the other medical care providers. There are four ambulance crews (one paramedic and one technician) and an ambulance incident officer at every game, with the Emergency Support Unit vehicle also in attendance. There are in addition another two ambulance paramedics and two technicians whose responsibility is the safe removal of injured players from the field of play. Finally there are 50–60 voluntary first aid workers from the St Andrew's Ambulance Association, whose skills and commitment are indispensable.

An essential responsibility of the crowd doctors is to manage the initial medical response to a major incident. Celtic has a major incident plan, which is regularly updated, most recently after a large tabletop exercise at the stadium last year. This was attended by the crowd doctors along with representatives of the club, the emergency services, and local authority services. It is hoped, however, that the likelihood of such an incident has been reduced substantially by measures such as all seated stadia, all ticket games, and improved stewarding.

The routine work of the crowd doctors is to treat the casualties referred to them by first aid or ambulance service workers. This is a study of all such consultations during the season 1999–2000.

Methods

An audit form (fig 1) was used to document every consultation with the crowd doctors during the season 1999–2000. In addition to the clinical notes, information was obtained about the patient's age and town of residence. An assessment was made of whether alcohol use was a contributing factor to the clinical presentation and of whether the reason for the consultation was directly related to attendance at the game. It was noted if the patient was attending the game in any capacity other than as a spectator.

Figure 1

Audit of consultations at Celtic Park, 1999–2000 season.

Results

There were 26 fixtures played: two preseason matches (average attendance 56 015), 18 Scottish Premiership League (SPL) matches (average attendances 54 542), three European ties (average attendance 48 739), one CIS Cup match (attendance 40 260), one Scottish Cup match (attendance 34 389), and one challenge match (attendance 20 000). The average overall attendance was 51 271.

A total of 127 casualties were treated by the crowd doctors, a mean of 4.88 per match. There were casualties at every game, in numbers ranging from one to 14; fig 2 shows the distribution. In the SPL, two home matches are played against each of the other nine teams in the league. Figure 3 shows the combined totals for these matches.

Figure 2

Number of casualties at each match.

Figure 3

Combined total of casualties at two games against each of the Scottish Premiership League opposing teams.

The mean age of the casualties was 29.62 years (range 2–73 years), 95 (74.8%) being male and 32 (25.2%) female, with 10 casualties (7.9%) being children under the age of 12. The home of 34 (26.8%) of the casualties was more than 30 miles from Glasgow, with seven (5.5%) being from England and three (2.4%) from Ireland. For 27 (21.2%), their attendance was judged to be an opportunistic use of medical advice and to have no relation to illness or accident on the day of the match. Of the total casualties, 21 (16.5%) were attending in a capacity other than as a spectator (table 1).

Table 1

Casualties seen while attending in capacity other than spectator

The effects of excessive alcohol had a substantial impact on the workload. For eight casualties (6.3%), inebriation was the primary diagnosis, and for another 18 (14.2%) it was a factor of major relevance. For another five casualties (3.9%), alcohol use was judged to be a minor contributing factor to their symptoms.

Of the total casualties, 20 (15.7%) were transferred to hospital for further assessment and treatment; in seven of these cases alcohol excess was the primary diagnosis or a major contributory factor. A further seven casualties (5.5%) were advised to seek further treatment from their own doctor or local accident and emergency department after the game.

There was one cardiac arrest, successfully resuscitated and transferred to hospital, with a subsequent satisfactory outcome.

Table 2 shows the very varied nature of the clinical presentations of the casualties seen.

Table 2

List of casualties seen at Glasgrow Celtic Football Club in the 1999–2000 season

Discussion

The workload of the crowd doctors was both variable, ranging from one to 14 casualties per match, and diverse, ranging from toothache to cardiac arrest. It included surprising episodes such as two young men presenting on separate occasions with bereavement reactions, and unusual episodes such as a young man successfully treating his rapid supraventricular tachycardia by plunging his head into icy cold water. The busiest matches were the traditionally tense local derby matches with the club's city rival Rangers (fig 3). We have no doubt from our experience of previous years that the more there is at stake in a match, the busier the crowd doctors will be. The season 1999–2000 proved to be a disappointing season for Celtic resulting in reduced attendances and a subdued atmosphere. The current season has, however, started well, and we expect an increased workload if this progress is maintained.

The single cardiac arrest was less than we expected from previous seasons, with recent experiences including two cardiac arrests within ten minutes at the same match, both successfully resuscitated, and another match where successive casualties presented with cardiac arrest and dissection of an aortic aneurysm. With the availability of skilled medical care and rapid access to defibrillation, a football match is now one of the least adverse circumstances in which to have a cardiac arrest.

A cause for concern is the significant impact of alcohol intoxication on our workload. Celtic Park is a very well stewarded ground, and spectators under the influence of alcohol are not admitted. In common with other Scottish football grounds, alcohol is not on general sale. There is, however, a regrettable culture of heavy drinking in Scotland, with many consequences for local health and social services. The effects of rapid ingestion of alcohol before matches may not become apparent until after spectators have been admitted into the ground. It is of particular concern that two of the casualties affected by alcohol intoxication were children aged 14 and 15. This is a trend that has continued since this study was completed.

The welcome social trend of football spectating becoming a family event is reflected in the relatively high numbers of women and young children requiring attention. Of note too is the proportion of casualties attending the match in a capacity other than as spectators (table 1). It is likely that this reflects both an awareness on their part of the facilities available, and also the responsibility on catering and stewarding supervisors to ensure that any injuries sustained by their staff at work are treated and documented.

Finally we were interested in the town of residence of the casualties, seeing this as a possible factor influencing management of the casualty. It proved to be a relevant factor in one case only, a far travelled driver who could not safely be discharged because of visual distortion due to migraine, and had to be transferred to the local accident and emergency department for observation.

Acknowledgments

We are grateful to the senior officials of Celtic Football Club for their encouragement of this article, and for the support of Dr J Mulhearn, club medical advisor, whose responsibilities include the coordination of the crowd doctoring service. We are especially grateful to our colleagues in the Scottish Ambulance Service and the St Andrew's Ambulance Association.

Take home message

Crowd medical care at football grounds requires cooperation among first aid workers, ambulance staff, and doctors. Doctors doing this work should have appropriate training and expertise.

References

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