Emergency Procudure for Refs.

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Albeit that Referees’ are not directly responsible for summoning medical help when a serious injury occurs, if you are the only one with a mobile phone, and the player is seriously injured, then football comes second. This advice does not assume that the Referee must take this action. The responsibility for summoning help would normally lie with the team trainers’, or if you are lucky, with a qualified first-aider.

From a football team perspective, it is important that one person should take responsibility for summoning help should an emergency occur. Nowadays, a mobile phone is usually available to contact medical help. If a mobile phone is not available, the nearest telephone to the field of play must be used. When arriving at the field of play, make a mental note of any telephone kiosks in the vicinity. The home team players should know where the nearest telephone is.

Although serious injuries in football are thankfully low compared to the number of games played, they do occur from time to time. Especially during England’s winter, when slippery and hard surfaces will increase the likelihood of a serious injury occurring. The question is - do the players (or do you the Referee, as a last resort) know how to summon help properly in an emergency?

CALLING FOR AN AMBULANCE: Take me to the top of this page

The 999 system was introduced in 1937 by the General Post Office for dealing with urgent calls from anyone who needed help from the Police, Fire or Ambulance services. It was gradually extended to cover the entire country but it was not until the late 1960s that the facility was available from every telephone.

On average, most people will only dial 999 once in their lives. Subsequently it can be a daunting process, particularly as the need to use the emergency service is always associated with an urgent need for assistance. Remember this service is free: You do not need to put money into a payphone to use it and the ambulance service will never charge you for attending an incident.

Please remember, if you think you might need to dial 999 but are not sure, then you do need to dial 999 and ask for advice. This is not considered to be a hoax call or a waste of time. There are still cases where people have failed to dial 999 because they 'did not want to bother anyone' and patients have suffered as a result. The ambulance service is there to help!

WHAT WILL HAPPEN WHEN YOU CALL 999?

You will firstly be connected to a BRITISH TELECOMMUNICATIONS (BT) OPERATOR who will be based in one of five emergency call centres in the UK (unless using a mobile phone - some mobile telephone companies have their own 999 operators). They will ask for your name, the telephone number you are calling from, and which emergency service you require. Your calling number is normally automatically displayed, but the operator may ask you to confirm the telephone number from which you are calling. It is not yet possible to pinpoint a mobile telephone number location, so be prepared to give detailed directions. All these details are entered onto a computerised logging system so it helps if you speak clearly and steadily.

Precise directions, including any landmarks in rural locations can be of great assistance in ensuring help gets to you as soon as possible

The operator will then connect you to the most appropriate AMBULANCE CONTROL CENTRE for the area you are calling from. The operator will pass on your caller number to the Ambulance Control. It is important that you stay quiet at this stage to avoid confusion, but it ensures that if you get cut off, the ambulance service can ring you back with the minimum of delay.

The Ambulance Control Staff will then ask you the following questions:

1. What is the exact LOCATION of the incident?

2. What is the PHONE NUMBER you are calling from?

3. What is the PROBLEM (Tell me EXACTLY what happened)?

4. (If not obvious) How MANY people are HURT (sick)?

5. How OLD is the patient?

6. Is the patient CONSCIOUS?

7. Is the patient BREATHING?

8. Is the patient MALE or FEMALE?

You may be asked more specific questions depending on the answers you have already given, and will be given FIRST AID ADVICE if it is required. Answering these questions does not delay ambulance response in any way. The questioning is done to ascertain the patient's most significant medical problem.

For example, a patient with serious bleeding or who is unconscious is more likely to need immediate treatment than a player with a suspected broken leg is.

Whilst the call is ongoing, the information is relayed electronically by the computer to a ‘Mobiliser’ who will send the nearest available ambulance crew to you. Only hang up after the operator instructs you that they have all the information needed. If the patient’s condition is serious, the operator may wish to stay on the line with you until the ambulance arrives. (For example, if you may be required (or need advice) to give the patient Cardio-Pulmonary Resuscitation (CPR) chest compressions and mouth-to-mouth resuscitation.

WAITING FOR THE AMBULANCE: Take me to the top of this page

Follow any First Aid advice given. Send a responsible person(s) to the road to meet the ambulance, so that the Ambulance Crew can be quickly directed towards the injured person. Ensure that the ambulance will have clear access to the player. (Is there vehicular access for the ambulance? Can the ambulance enter through a gate? Is the gate locked? Is there a key?). Forward planning may save lives. Ask inquisitive spectators to leave the scene.

A quick note on SHOCK!

When considering the severity of any serious injury, be aware of the casualty suffering from ‘SHOCK’ as a result of the trauma of the injury. Always try and make the casualty comfortable and keep them warm and dry when the weather is cold or wet.

The body reacts to traumatic shock by directing more blood to the arteries supplying the vital organs (e.g. brain heart and kidneys) at the expense of those supplying the less important tissue (e.g. muscle and skin). Symptoms of shock include, feeling weak, faint, giddy anxious and restless. Casualty may vomit, feel thirsty, breath shallow and rapidly inducing yawning and sighing. Skin becomes pale or grey in colour (particularly the lips), cold and moist with sweat. Pulse increases and but becomes weaker and sometimes irregular as the blood/fluid drops. Unconsciousness may develop. There may be evidence of associated external or internal injury. First aid treatment involves reassuring the casualty, keeping the head low by lying down and turning the head to one side to increase blood to the brain and lessen the dangers of vomiting. Do not unduly move the patient. The legs should be raised - but not if a leg is fractured. Keep warm but do not apply a hot water bottle. Loosen any tight clothing. Do not have anything to drink (this will delay any subsequent administration of anaesthetic for emergency treatment to any serious injury) - but the lips can be moistened. No smoking allowed. Shock can materialise many hours after the incident, so look out for any of these symptoms. Seek medical attention immediately. Shock can kill.

Many thanks to the Pre-hospital Emergency Research Unit, College of Medicine' for permission to use their excellent content describing the emergency call procedure used in England.

Many thanks to the Pre-hospital Emergency Research Unit, University of Wales College of Medicine' for permission to use their excellent advice describing the emergency call procedure used in England. And to my daughter Melanie who is a trainee paramedic.

January 2002

Julian Carosi (webmaster).

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