Barring the odd exception (usually goalkeepers), professional footballers are extremely fit athletes. Football is a very physical and intensive game after all with all outfield players required to cover a lot of ground in the space of 90 or occasionally 120 minutes. Just to be sure though, when moving clubs, it is standard practice for the buying team to perform what is known as a medical on their prospective recruit. In most cases, these medicals take place without any issues being flagged up and they are little more than a formality.
Advancements in fields such as nutrition and physiotherapy have all served to make footballers fitter than ever. The modern-day professional player will boast extremely impressive stats whether it is their resting heart rate, VO2 max, or other common indicators. Given this, you might be wondering why we really need to bother having stringent medical protocols at football stadiums specifically for the players. Such elite athletes should never run into any bother, should they?
Why Do Football Matches Need Medical Provision?
While it seems at first like a fairly logical assumption that these athletes need little attention, footballers are not immune from suffering a serious injury or life-threatening condition on the pitch. Firstly, you can have incidents resulting from the competitive nature of the game. A clash of heads, a fractured leg following a reckless challenge, a player falling awkwardly following an aerial duel; these are all risks of the game that cannot be fully eradicated. In addition to this, you also have instances of cardiovascular conditions such as a cardiac arrest or a heart attack. While these are much less likely to occur in fit, young athletes, conditions such as SADS (sudden arrhythmic death syndrome) can strike almost at random regardless of how fit you are.
Therefore, it is absolutely vital for footballers’ welfare that strict medical requirements are in place not only for competitive matches but in training too. Exact rules can differ between nations but to give you an idea of the things you are likely to find, we will share details of what UEFA provide in their guidelines (published in 2019). These rules impact all UEFA conditions such as the Champions League, the Europa League and the European Championships (Euros).
Medical Care Requirements
We will now cover everything that UEFA specifies to be a minimum requirement when it comes to medical care within football stadiums. Everything mentioned below must be met while there are additional items/measures that UEFA only have as recommendations. So, it is possible that a stadium may feature more than what is listed below. Usually UEFA update their requirements on an annual basis although the guidelines rarely change much year on year as they have long served their purpose well.
Pitchside Medical Equipment
Sitting by the touchline you will find substitutes and coaching staff but also equipment and staff who are there to react to medical issues. Although most likely out of the view of the cameras, hiding somewhere will be a large medical equipment bag including lots of essential gear. To meet the regulations, a bag must contain the following items included below.
- Airway and cervical spine
- Handheld suction device
- Respiratory resuscitators with masks and airways
- Lubricant
- Cervical collar set/rigid neck brace
- Breathing
- Stethoscope
- Pulse oximeter
- Oxygen/trauma mask and tubing
- Pocket mask
- Bag valve mask
- Spacer device for bronchodilators
- Portable oxygen cylinder
- Circulation
- Infusion equipment
- Defibrillator (AED)
- Blood pressure monitor with appropriate cuff size(s)
- Blood sugar gauge and/or blood sugar test sticks
- Emergency Bag Drugs bag drugs
- Adrenaline 1:10,000 injection
- Antihistamine
- Hydrocortisone
- Benzodiazepines
- Cardiac lifesaving drugs
- Epipen or anapen
- Bronchodilators
- Glyceryl Trinitrate spray
- Glucose tablets/gel
- Emergency diabetes drugs
- Antiemetics
- Large Pitchside Equipment
- One spinal board, scoop stretcher or vacuum mattress, with compatible fixing equipment
- Box splints
- Other equipment (small)
- Tourniquet
- Adhesive fixing materials
- Pupil lamp
- IV cannula of various gauges
- Strong scissors
- Disinfection equipment
- Disposable gloves
- Sharps box
- Protective goggles
There is no set requirement for the bag itself although needless to say it will be a lot bigger than the backpacks that most people take with them to work.
Ambulance
It is mandatory to have an ambulance at the stadium for all UEFA competitions. You cannot just hire any old ambulance though as it has to be there solely for the use of the players, team officials and match officials. The ambulance must arrive at least one and a half hours before the match starts and stay on the premises until one hour after the full-time whistle.
To fulfil UEFA requirements, the emergency vehicle must contain a fully equipped emergency bag. This is a separate bag from the emergency pitchside bag but one that contains all the same equipment. It in addition though, it must have portable oxygen that can provide at least 15 litres per minute for 20 minutes. Lastly, the ambulance will also need to contain a minimum of one paramedic.
The positioning of the ambulance is also something that UEFA raises as an important consideration. Optimal placement of the ambulance would permit a quick exit from the pitch area/dressing room.
Medical staff
As you might expect, it is down to the host team, rather than the visiting side to ensure that there is one pitchside emergency doctor available for the duration of the game. Now, this figure can be the home club’s own team doctor but only providing that they have a good knowledge of English (ideally fluent) and are qualified in emergency first aid techniques. Should their own doctor fill this post, the home club would have to ensure that another individual is appointed to facilitate a medical evacuation if required.
The home side will also be responsible for having the stretcher team on standby. Although you may have seen the video of two hapless stretcher-bearers dropping Leonardo Koutris in a Greek second division match, do not think your average bearer is this poorly trained. UEFA actually state that a stretcher team must have two trained carriers with previous experience and a first aid qualification. Any additional stretches would not need to have this requirement but would obviously need to be physically fit enough for the job.
Emergency medical room and equipment
Another list for you here but with one big difference. Everything included below does not need cramming into a bag, rather it needs to be available in the stadium’s medical room. A medical room must be located close to both the home and away dressing rooms and on the same floor. It also needs to be large enough to provide stretcher access, so that means no narrow corridors.
- Medical room equipment
- Examination and treatment table/couch
- Two chairs
- Suture materials of more than one filament size
- Suture packs
- Sharps box
- Hand gel
- Dressing packs
- Urine rapid analysis dipsticks
- Copy of the current WADA Prohibited List
- Ice and plastic bags
- Local anaesthetics
- Mirror
- Bright light
- Syringes
- Needles
- Tongue depressors
- Foil blankets
- Penlight
- Alcohol swabs
- Gloves
- Bandages
- Wound cleaning solution
Many medical rooms will also include the list of items UEFA recommends (below) but does not make compulsory.
- Recommended medical room equipment
- Stethoscope
- Nebuliser mask
- Opthalmoscope and auroscope
- Nasal tampons
- Prescription pad
- Anti-histamines (chlorpheniramine injection)
- hydrocortisone
- Running water
- Toilet
- Benzodiazepines (e.g. Sublingual diazepam or diazemuls injection)
- Adrenaline 1:10,000 injection
- Tooth transport container (medium)
- Portable oxygen cylinder (minimum 15l/min. For 20 minutes)
Pre-match information
Medical care at football stadiums cannot be something that is sorted out at the very last minute. Instead clubs need to be very much on the ball with things before hosting matches. At a minimum of two weeks before a game, UEFA require teams to provide details of the name and phone numbers of the pitchside emergency doctor and the stadium doctor (if different). They require a clear map of the ground which indicates where the ambulance will be located, the exit point(s) for the ambulance and the whereabouts of the medical room.
Alongside the map, the home side must also provide a detailed emergency evacuation plan relating to any serious injury that occurs on a match day. Finally, UEFA need informing of the address of the nearest hospital that has the necessary emergency facilities.
Pre-tournament information
Major tournaments such as the Euros require years of planning and even things you barely notice on the TV screens like medical care will have been sorted out weeks if not months prior. There are all kinds of considerations that UEFA need informing of such as evacuation plans, responsibilities of key medical personnel and medical communication procedures. A detailed plan also has to contain broader considerations such as immunisation requirements of the host nation and confirmation that the visiting team’s own doctor will have the right to practice medicine upon arrival.
At least three months prior to the start of a tournament, UEFA will require the name and contact details of the tournament doctor, who must be fluent in English. The chosen doctor faces a huge responsibility as they must be available 24 hours a day, seven days a week starting from when the first team arrives until the last team leaves. In addition, they must live close by to the tournament with accommodation provided for them if necessary.
What about lower league matches?
The guidelines discussed in this article cover specifically the UEFA Champions League, the UEFA Europa League, the UEFA Super Cup, the UEFA European Football Championship and the UEFA European Under-21 Championship. All other (lesser) UEFA competitions must also follow set rules but of a less stringent nature, for example, there is no requirement for having an emergency pitchside doctor.
While you will see many of the same requirements for many of the top leagues across Europe, this stops being the case further down the pyramid. Among the lower leagues, you will find that the measures in place become much less strict simply because of the costs involved and/or limited available resources. It just is not possible to have an ambulance waiting at every professional and semi-professional game in the country. At the absolute lowest tiers on the pyramid, so amateur football, many players only have access to a medical bag feature little more than deep heat spray and a magic sponge.
So, if a player is unlucky enough to sustain a physical injury say a stadium with a couple of hundred spectators in attendance, chances are they will not receive a high level of care. This was painfully highlighted in a Conference South game involving Truro City in which Michael Herve had to wait over two and a half hours for an ambulance following a suspected broken arm. For anyone suffering from a heart issue though, the situation is improving thanks to the increase in publicly availably defibrillators.
There has been a real push in recent years, in many countries across the world, to increase the number of defibrillators. Anyone living in a UK city for instance should be within a few minutes of their nearest one. Some campaigners have been more specific in their focus and are aiming to have a defibrillator at every football ground in the country. If using the device within three to five minutes of a player collapsing, the chance of survival should be between 50% and 70%. Every second counts when attempting to restart a normal heartbeat so having a defibrillator nearby can potentially save lives of amateur, semi-pro and professional players.
Is There Enough Medical Support at Football Matches?
As you can see, UEFA take medical support extremely seriously across their more elite competitions. It is precisely because of this that we avoided a potential tragedy when Christian Eriksen suddenly collapsed in a Euro 2020 group stage clash with Finland. Trained medical personnel, equipped with all the key gear, rushed to his aid while there was an ambulance on standby ready to take him to the nearby hospital. Despite suffering a cardiac arrest, the fantastic procedures and staff in place ensured Eriksen survived the ordeal in a remarkably resolute fashion.
Sadly, it is inevitable that not all future cases of heart problems on a football pitch will play out like they did with Eriksen. We have already seen real tragedies occur with the likes of Marc-Vivien Foé and Phil O’Donnell who both sadly died after collapsing on the field of play. With the aid of these stringent rules though, the chances of such an incident happening again will likely decrease, at least in high-profile matches.
At much lower levels of the footballing pyramid, where it is not feasible to have medical personnel on standby, the key weapon in the fight against such tragedies is the availability of defibrillators and people’s ability to use them confidently. Thankfully both awareness and resources are increasing to make defibrillators more widely available.