The Event Medical Team and Command

The Green Guide identifies the key medical personnel as a Medical Coordinator, Event Doctors and Event Practitioners, and first aiders. The plan names the numbers, the duties and the location of every member of the team, rather than a total, and the composition follows the medical needs assessment rather than a habit.

The Medical Coordinator oversees the delivery of the service, and where a ground has one they may also be the person who conducts the medical needs assessment. At a smaller event the role may be a named person who is unambiguously in charge, but somebody holds it.

Two practicalities carry more weight than they look. Everyone is clearly identifiable, by uniform, high visibility jacket or tabard, because a clinician nobody can find is not cover. And welfare facilities for the medical personnel belong in the plan, since a team working a sixteen-hour day in a field has needs of its own.

This is where the Green Guide is unusually specific, and it is worth knowing because current competence alone does not satisfy it. An Event Doctor must be a Registered Medical Practitioner with a current licence to practise, with proof that their pre-hospital work is reviewed through annual appraisal and five-yearly revalidation. They must hold appropriate professional indemnity. They must have completed one of the approved pre-hospital training courses and one of the approved major incident courses, and be trained to undertake major incident triage in line with ambulance service clinical guidelines. They must have clearance from the relevant disclosure and barring service or equivalent. And they must have taken part in testing the management's contingency plans.

The approved courses are named. The pre-hospital course is the Pre-Hospital Emergency Care course, run by the Royal College of Surgeons of Edinburgh or by the British Association for Immediate Care. The major incident course is Major Incident Medical Management and Support, endorsed by the Advanced Life Support Group.

For events between two thousand and ten thousand spectators it may be acceptable, if justified, to deploy an Event Practitioner instead of an Event Doctor. They do not need the medical registration, but they must meet the requirements for professional healthcare certification, training, qualification and registration with a relevant licensing body. In practice they are drawn from registered clinicians such as paramedics or nurses working at specialist or advanced practitioner level.

Notice what that list actually says. Attending the course is not the point; the appraisal, the revalidation, the indemnity and the contingency exercise are all continuing obligations, and a doctor who did the course in 2019 and has not tested a plan since does not meet it.

The plan sets out the command structure, the lines of responsibility and the decision-making protocol within the medical team, and that requirement bites hardest where the team comes from more than one provider. Two organisations on site with no agreed structure is not a team; it is two teams who will discover the problem at the worst possible moment.

It also sets out the coordination and communication within the team, the interaction with the ground's safety management team, and the link to providers outside the ground. That middle one is what people underestimate. The Safety Officer leads the tactical and operational decisions about venue safety. The Medical Coordinator leads the medical operation. Individual clinicians retain responsibility for their own clinical decisions. And some decisions belong to neither of you, because competition officials hold their own sport-specific authority.

Knowing your lane is not deference. It is what lets you say, clearly and to the right person, that you need the crowd moved or the gate opened, and be understood.

Registration and regulation are checked before the day rather than assumed from a title on a rota. Where ambulance provision is involved, whether a provider must be registered depends on the activities they are providing, particularly transport off site, rather than on an ambulance simply being present. Registration is with the Care Quality Commission in England, or with the equivalent regulator elsewhere in the UK.

The training and competency of medical personnel is itself one of the safety management factors in the medical needs assessment, so competence is not only a governance question. It is an input to how much cover the event needs, because a team that can do less needs to be larger or needs help sooner.

A Medical Advisory Group may be formed where it is locally useful, overseeing medical and first aid provision and reporting its recommendations to the Safety Advisory Group. It advises rather than decides, which is the same limit that applies to the group it reports to.

The Medical Plan is reviewed annually. Where there has been a serious incident or a near miss, the relevant sections are reviewed and updated before the annual review comes round. And it is reviewed again on any change of medical provider or of circumstances, such as an expansion of the ground's capacity.

• •The Sports Grounds Safety Authority sets out that medical and first aid provision at a sports ground relates to spectators, staff and personnel, with separate arrangements for athletes, players and officials determined by the sport's governing body, while the medical needs assessment must still consider the likelihood of an athlete or official needing treatment from ground-commissioned personnel.
• •The Green Guide sets out what an Event Doctor must hold: registration with a current licence, annual appraisal and five-yearly revalidation of pre-hospital work, professional indemnity, an approved pre-hospital course and an approved major incident course, major incident triage training in line with ambulance service clinical guidelines, disclosure clearance, and participation in testing the contingency plans. The approved courses are the Pre-Hospital Emergency Care course and Major Incident Medical Management and Support.
• •Between two thousand and ten thousand spectators an Event Practitioner may be deployed instead of an Event Doctor where justified, meeting the requirements for professional certification, training, qualification and registration with a relevant licensing body.
• •The Medical Plan sets the command structure and decision-making protocol within the medical team, particularly where several providers are involved, and the interaction with the ground's safety management team.

• •Provision is built around spectators, staff and personnel; athlete cover is arranged separately.
• •The assessment still considers athletes needing treatment from ground-commissioned personnel.
• •An Event Doctor needs an approved pre-hospital course and an approved major incident course.
• •Appraisal, revalidation, indemnity and contingency testing are continuing requirements.
• •Between two thousand and ten thousand, an Event Practitioner may substitute if justified.
• •The Safety Officer leads venue safety; the Medical Coordinator leads the medical operation.