Editorial
Br J Sports Med: first published as 10.1136/bjsports-2021-105126 on 14 February 2022. Downloaded from http://bjsm.bmj.com/ on September 5, 2024 by guest. Protected by copyright.
Set-piece approach for medical teams and is ultimately responsible for coor-
dinating the emergency response. This
role can be assumed initially by the first
managing emergencies in sport: responder (often the team doctor) who
would perform the initial on-field assess-
introducing the FIFA Poster for ment and begin management, before
moving to a more hands- off role to
Emergency Action Planning (PEAP) coordinate the response, or hand over
these responsibilities to a pre determined
team leader (when they arrive on scene).
Michael Patterson,1 Jonny Gordon,2 Stephen H Boyce,3 Sarah Lindsay,4 Regardless of the clinical scenario, the
Dexter Seow ,5 Andreas Serner,6 Kevin Thomson,7 Graeme Jones,2 process for the emergency response
should not change, so time-critical and
Andrew Massey 6 life-
threatening clinical issues (such as
sudden cardiac arrest or thoracic trauma)
are not missed due to the prioritisation
‘Does your colleague know what to do team dynamics to a more proactive team of more eye- catching issues (such as
on the pitch in case of a medical emer- preparation model. angulated fractures).
gency? Do you?’ When traumatic and This scripted and reproducible process
non-traumatic emergencies in football PROACTIVE TEAM BEHAVIOUR: THE necessitates team practice and scenario-
(soccer) occur, it is imperative that the SET-PIECE based training by the medical staff and
healthcare professionals responsible for Regardless of where the emergency takes designated responders to minimise stress
players are trained and equipped to place, the clinical elements for recog- and improve efficiency when called into
recognise and provide appropriate care.1 nising and managing a medical emer- action.3
To support and promote a consistent gency or trauma remain the same. The
level of emergency medical care on the football terminology of a ‘set-piece’ has TASK ALLOCATION
football field, reduce errors and limit been borrowed to describe the optimal One of the major challenges in providing
human errors, the Fédération Interna- process—where a team practises for a medical care for football is the incon-
tionale de Football Association (FIFA) predicted scenario, with each member sistency in resources available within
proposes a standardised protocol for designated a role to perform and the venues. The FIFA PEAP aims to add
medical teams managing emergencies in accumulation of these roles leads to the a consistent approach that can be
sport: the Poster for Emergency Action goal. adopted by most multidisciplinary teams
Planning (PEAP).2 Set-
piece thinking permits optimal (MDTs) and defines the minimal clinical
The FIFA PEAP (figure 1) illustrates a team performance by allowing each indi- resources and associated skills required
process by which medical teams organise vidual to remain task- focused without for each role.
themselves to deliver prioritised care in distraction. A team leader or ‘captain’ of The PEAP is designed for all stake-
emergency scenarios and minimises the the medical team should be predesignated holders in football, in both competitions
risks that are inherent when working in
the complex and often publicly viewed
prehospital environment of compet-
itive football. By linking key clinical
interventions with predetermined roles,
the PEAP helps teams manage the chal-
lenging human factors inherent in a
time-critical emergency on the field of
play. Importantly, the FIFA PEAP moves
away from the more traditional reactive
1
Consultant in Intensive Care & Emergency Medicine,
Chief Medical Officer, Venues, Events & Emergency
Care, Football Association, London, UK
2
Medical Department, Scottish Football Association,
Glasgow, UK
3
Sport Medicine, Sports Institute of Scotland, Glasgow,
UK
4
Liverpool Football Club, Liverpool, UK
5
National University Health System, Singapore
6
Medical Department, Federation Internationale de
Football Association, Zurich, Switzerland
7
Queen Elizabeth University Hospital Campus, Glasgow,
UK
Figure 1 The FIFA Poster for Emergency Action Planning. The names of the person responsible
Correspondence to Dr Andrew Massey, Medical and
Anti Doping Department, Federation Internationale de
should be entered into the coloured spaces. Each required role (colour) is described in detail in
Football Association, 8044 Zurich, Zürich, Switzerland; table 1. Please see (online supplemental figure 2) for more detail on the 2021 FIFA emergency bag.
andrew.massey@fifa.org AED, automatic external defibrillator; FIFA, Fédération Internationale de Football Association.
Patterson M, et al. Br J Sports Med July 2022 Vol 56 No 13 715
Editorial
Br J Sports Med: first published as 10.1136/bjsports-2021-105126 on 14 February 2022. Downloaded from http://bjsm.bmj.com/ on September 5, 2024 by guest. Protected by copyright.
to resuscitate and stabilise a patient and the
Table 1 Team members and roles for the FIFA emergency action plan
skills required to deliver these procedures.
Role Skills MDT member example Responsibility This focus allows the integration of clini-
Team leader Team coordination and Doctor If performing the initial cians with emergency competencies (such
communication Senior paramedic assessment, move to “Hands as doctors, paramedics and nurses) and
Good understanding of clinical Nurse with the resuscitation leader Off’ role when able:
prioritisation in emergency care role Should avoid becoming
allied health professionals with other skills
Clear situational awareness task-focused and only be (such as physiotherapists, athletic trainers,
involved in practical skills if sports therapists and first aiders) into a
absolutely required. MDT.
Responsible for delegating
key equipment to other roles
(such as AED/medical gases/
airway equipment). PRACTISING TO PERFECTION
Responsible for coordinating Within the PEAP, roles are allocated and
the team, defining clinical
practised prior to the deployment of the
priorities, and maintaining
an overview. team so when an emergency takes place,
Responsible for garnering team members are already aware of their
pertinent medical role and responsibilities in the process.
information relating to These are colour coded and represent the
the patient, from the team
medical staff. positions and responsibilities each member
Head/neck Recognise potential cervical- Doctor Primary communicator with should take during a scenario—as described
spine injury and apply manual Physiotherapist patient in figure 1. Each club may have personnel
in-line stabilisation (MILS) Athletic trainer Cervical-spine MILS to fill each of these roles and practise their
techniques Paramedic Airway management emergency response together before the
Perform airway management (or EMT Leading team in log-roll or
exchange with more qualified spine boarding technique.
start of the season. In some circumstances,
responder) in unconscious the visiting team may require personnel
patients (including iGel LMA from the home team to fill all roles. This
insertion in sudden cardiac should be determined before match day
arrest).
and role allocation should take place at the
Chest Able to perform initial primary Doctor Initial assessment (including
Prematch Medical Meeting (suggest 1 hour
clinical assessment (ABCDE) Paramedic starting as team leader while
Experienced in recognising EMT team assembles) prior to kick-off) or in a pretraining briefing.
sudden cardiac arrest or signs of Ensure safe airway and As part of adopting the PEAP, teams should
significant injury application of oxygen when introduce time for this key communication
Capable of performing basic required
or so- called ‘medical timeout’ into their
airway manoeuvres and chest Start CPR
compressions Torso control in log-roll regular preactivity routine.
Equipment Understands the use and Paramedic Bring FIFA Bag and AED.
deployment of all medical EMT Deployment of medical
equipment allocated to the team First Aiders/AHPs equipment in line with the CREATING STRONG TEAM
(although does not need to be clinical scenario COMMUNICATION
skilled in its use) Liaison with any other venue
Able to carry relatively heavy stretcher team personnel A synchronised, well- practised set-
piece
resources to support the team to assist the team leader in allows teams to work efficiently and without
coordinating extrication getting in each other’s way. However,
Responsible for the safe the task- focused element of most team
clearance and removal of
medical equipment from the
members’ roles places increasing importance
field of play on communication and the hands-off over-
Pelvis Perform basic medical manual EMT Pelvic control in log-roll sight of the team leader.
handling and assist clinicians in First Aiders/AHPs Assists with CPR (if trained) Communication within the team is key,
patient care May be designated specific allowing team members to feedback through
Trained in the application of equipment to assist Head
the team leader who provides situational
spinal immobilisation and patient & Chest roles (AED/medical
movement equipment gases/airway equipment) awareness and coordinates the set-piece. The
Legs Perform basic medical manual EMT Leg control in log-roll team should practice closed-loop communi-
handling and assist clinicians in First Aiders Assists with CPR (if trained) cation where the team member alerts the rest
patient care AHPs May be designated specific of the team via the team leader when each
Trained in the application of equipment to assist head/ task is delivered.
spinal immobilisation and patient neck and chest roles (AED/
stabilisation equipment (such as medical gases/airway It is inevitable that team communica-
spider straps and vacuum splints) equipment) tion and performance will be challenged
AED, automated external defibrillator; AHP, allied health professionals; CPR, cardiopulmonary resusicitation; EMT, by stressful, time-critical medical emer-
emergency medical technician; FIFA, Fédération Internationale de Football Association; LMA, laryngeal mask airway; gencies, and so the PEAP is designed as a
MDT, multidisciplinary team. reference document for use during team
activity. All roles and communication
channels should refer back to the FIFA
and training. It is an umbrella process that systems and those with more moderate PEAP as a tool to maintain clear team
is equally applicable to venues with already resources. To achieve this, we have placed direction, organisation and leadership in
established high- functioning emergency emphasis on the key interventions required times of stress.
716 Patterson M, et al. Br J Sports Med July 2022 Vol 56 No 13
Editorial
Br J Sports Med: first published as 10.1136/bjsports-2021-105126 on 14 February 2022. Downloaded from http://bjsm.bmj.com/ on September 5, 2024 by guest. Protected by copyright.
CONCLUSION Competing interests None declared.
A medical emergency in football is a Patient consent for publication Not applicable.
challenging and stressful situation for Ethics approval This study does not involve human To cite Patterson M, Gordon J, Boyce SH, et al.
any clinician. To provide the most effi- participants. Br J Sports Med 2022;56:715–717.
cient response, to best prioritise care Provenance and peer review Not commissioned; Accepted 27 January 2022
and optimise the medical team’s perfor- externally peer reviewed. Published Online First 14 February 2022
mance, we recommend moving away
Br J Sports Med 2022;56:715–717.
from reactive team dynamics to a proac- doi:10.1136/bjsports-2021-105126
tive team preparation model. The FIFA
PEAP provides a structure by which any ORCID iDs
medical team supporting the field can Dexter Seow http://orcid.org/0000-0003-1769-9244
deliver a reproducible system using a set- Andrew Massey http://orcid.org/0000-0002-8253-
Open access This is an open access article distributed 932X
piece process to ensure optimal player in accordance with the Creative Commons Attribution
care when a medical emergency presents Non Commercial (CC BY-NC 4.0) license, which permits
itself. others to distribute, remix, adapt, build upon this work REFERENCES
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Patterson M, et al. Br J Sports Med July 2022 Vol 56 No 13 717
