Sideline preparedness is the recognition and formation of medical services in order to promote athletic participation, provide adequate administration of medical care, and reduce risk of injury.

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  It is achieved by having a unified system with qualified medical staff, pre-event preparation, game-day preparation, and post-event evaluation.

  
  
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  Many factors influence the type of injuries and emergencies that occur, and it is critical that the director of medical services is knowledgeable about the demands of the competition. Medical services will vary widely among a multiday competition, a 1-day Ironman race, an American football game, and a gymnastic meet.

  
  
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  During any sporting event, availability of medical services for participants, volunteers, and spectators is extremely vital. The extent of services is often part of a signed contractual agreement.

  
  
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  The medial team may consist of one individual physician or athletic trainer or may include several different healthcare professionals. The medical staff may be paid for their services, provided in-kind services, or unpaid volunteers with varying levels of knowledge, degrees, specialties, and experience.

Pre-event planning and practice are imperative to improve safety measures, reduce risks to athletes and spectators during event participation, and provide appropriate medical care.

Game-day planning is essential as it streamlines medical care for those injured on site.

Post-event evaluation is also critical in order to provide continuing care for the injured and to provide strategic information for improvement in future events.

Director of medical services

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  Is usually a physician but may be an athletic trainer or other healthcare provider; physician should be qualified MD or DO with an unrestricted medical license along with training and certification in sports medicine and knowledge of common sports injuries and illnesses

  
  
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  Responsibilities include:

  
  
  
  
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    Making decisions regarding the health of all players

    
    
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    Assembling the medical staff

    
    
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    Creating and rehearsing an emergency activation plan (EAP) and chain of command for practice and game environments

    
    
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    Being available at all times or have back-up coverage

    
    
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    Coordinating care among others associated with the team

    
    
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    Responsibility for medical transfer of injured or ill athletes and for clearing athletes to play

    
    
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    Safety assessment of the practice facility, event environment, and playing conditions

    
    
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    Providing appropriate documentation of medical care

    
    
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    Possible involvement in the development of drug testing protocols, treatment, and prevention programs

    
    
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    Communication with athletes, parents, administrators, coaches, athletic directors, general managers, owners, media, sports agents, legal experts, and others regarding any health issues related to sports participation

  
  

Associate physicians

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  Should also be MD or DO with unrestricted license to assist the medical director; this may include various orthopedic surgeons and primary care physicians with interest and training in sports medicine

Additional physicians

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  May be required by league rules and can include trauma surgeons, neurologists/neurosurgeons, cardiologists, plastics surgeons, ophthalmologists, maxillofacial surgeon, dentists, dermatologists, and others

Head athletic trainer

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  Certified, with an unrestricted license, and is a critical member of the healthcare team

  
  
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  Works closely with the team physicians

  
  
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  Provides all aspects of medical care

Other key members who may be included in successful sideline preparedness are assistant athletic trainers, exercise physi­ologists and strength and conditioning coaches, physical therapists, nurses, psychologists, dietitians, chiropractors, massage therapists, paramedics, and emergency medical technicians (EMTs).

Medical equipment needs are substantially variable and are dependent on several factors such as the type of medical personnel in attendance; timing, duration, and location of the event; available on-site medical facilities; number of participants and spectators; access to medical facilities; expense; and league policy.

Pre-event communication among medical providers will better ensure that all equipment needs are met, and unnecessary duplication of equipment is minimized.

The medical director needs to know what supplies are available on site and what is available at local medical facilities.

On-site supplies may be provided by the physician; an athletic trainer or physical therapist; the organization or team; and/or the paramedic or EMT squad.

Required and/or essential and recommended and/or desirable supplies are listed in Table 4.1 .

The medical staff should be aware of common injuries and illnesses that occur during the sporting event for which they are to provide medical coverage; this may be accomplished by reviewing epidemiologic data, injury reports from previous similar events, published research, sports medicine textbooks and literature, and previous personal experiences. Having this knowledge will assist the medical staff in the creation of strategies and policies to promote athlete health, optimize medical care, and prevent any injury that may occur during the sporting event.

The medical staff may be required to clear athletes with medical disorders and identify those at a risk of health issues related to participation.

The medical staff should visit the course/venue to inspect for safety risks, location of training rooms and medical treatment facilities, optimum positioning of medical staff during the event, and ambulance/emergency egress routes.

The event EAP and injury protocols must be written, rehearsed, and practiced with all members of the healthcare team, and everyone should have a clear understanding of their roles and responsibilities in the event of a medical emergency.

Successful care during a sideline emergency is achieved with regular practice drills of emergency situations.

Game-day responsibilities will vary with the type of sporting event being covered and the venue where it is being held.

The medical staff should arrive early, at least an hour before the start of the event. This will allow time to meet with other members of the medical staff, coaches, and administrators; opposing team medical personnel and administrators; game officials; paramedics/EMTs; security and law enforcement members; and other volunteers.

Dress appropriately for the event and make sure to have appropriate medical credentials. Standardized clothing will allow for easy identification.

It is critical to ensure that every member of the team understands what role they play in case of an emergency, and also allow time to rehearse and review the EAP.

The medical team should meet with the opposing team’s medical staff to ensure they have adequate medical coverage, know how to activate the EAP, and rehearse injury scenarios.

Determine who will be the first providers to tend to an injured athlete and the means of communicating with other staff to assist with care. In addition, determine who will be providing care to spectators, officials, coaches, volunteers, and others in attendance.

The medical director should review medical equipment and supplies, assess the sports venue and examination and treatment sites, evaluate environmental and weather risks, determine the closest medical facilities, and ensure that appropriate medical communication systems are in working order.

May be required to determine final clearance for injured athletes to return to play

Will assess and manage game-day illnesses and injuries, determine if the patient may be treated on site or requires urgent/emergency transportation, and if the athlete may return to game-day participation

Physician expertise and experience have an impact on game-day return to play. One must consider if the disorder may be worsened by participation, predispose the athlete to other health risks, or place others at an increased risk of injury or illness.